Leanne Yinusa-Nyahkoon studies how adverse pregnancy and birth outcomes affect Black women. She′s also a mother herself. Photo by Michael D. Spencer

Public Health

Web-Based Program Could Decrease Pregnancy Risks for Black Women

BU researcher Leanne Yinusa-Nyahkoon is working on a digital health tool that provides healthcare support earlier—even before conception

Black women have long faced higher odds of pregnancy and delivery complications—and many have died as a result. In 2018, the issue received headlines when two celebrities experienced life-threatening childbirth complications: professional tennis player Serena Williams developed blood clots in her lungs following an emergency C-section while superstar singer Beyoncé Knowles-Carter was on bed rest due to preeclampsia prior to her own emergency C-section.

In the United States, Black women are currently three to four times more likely to die of pregnancy or delivery complications than white women. These stark disparities in adverse birth outcomes are inextricably linked to implicit bias and poorer quality of medical care. Alarming stories like Knowles-Carter’s and Williams’ are more than familiar to Leanne Yinusa-Nyahkoon, an occupational therapist at Boston University who has devoted her career to health disparities research.

Yinusa-Nyahkoon (CGS’98, Sargent’01,’03,’09), a BU Sargent College of Health & Rehabilitation Sciences clinical assistant professor of occupational therapy, began her career in pediatric occupational therapy serving diverse urban communities. Early on, she noticed the children she treated were predominantly Black. She wondered, “Is this just a coincidence that all these children have these learning, physical, or intellectual disabilities? Or, is there an underlying factor?”

During her doctoral studies at Sargent, Yinusa-Nyahkoon investigated the ecological barriers contributing to racial disparities in childhood asthma. She uncovered a common, underlying thread of social forces that include systemic racism, discrimination, and judgment from healthcare providers, and clients feeling alienated within healthcare settings.

After graduating with a doctorate, Yinusa-Nyahkoon shifted her focus. Pregnancy and birth outcomes, including maternal mortality, preterm birth, low birth weight, and infant mortality, disproportionately afflict Black mothers and babies in the United States. After studying developmental disabilities and asthma, examining birth outcomes “was just continuing the thread,” says Yinusa-Nyahkoon. “It’s still the same underlying factors.”

Income and educational inequities, the criminal justice system, racist housing policies, poor infrastructure in neighborhoods, and the dearth of Black healthcare providers are some of the many social factors that lead to disparities in maternal, infant, and child health. These forces, she says, contribute to young Black women having little to no access to needed products and technology, inadequate supports and relationships, skeptical attitudes about healthcare, and services, systems, and policies that were designed without them in mind.

In 2009, Yinusa-Nyahkoon joined the Gabby System project, which is focused on improving three main birth outcomes for Black women and their children: infant mortality, preterm birth, and low birth weight.

“[The Gabby team is] making a transition to also focus on maternal mortality, because those numbers are appalling,” Yinusa-Nyahkoon says.

A virtual solution for a real problem?

Gabby is an embodied conversational agent: an animated, virtual character that assesses the health of young Black women and delivers evidence-based health information to address individual needs and guide health behavior change. The goal of the Gabby System is to improve young Black women’s overall health and the likelihood of having a healthy pregnancy and delivery—by intervening before a woman even gets pregnant.

One of the team’s motivating factors for creating Gabby is that prenatal care may be addressing maternal and infant health too late. Health behavior change often takes longer than the prenatal period, and according to the United Health Foundation’s America’s Health Rankings, an estimated 30 to 45 percent of pregnancies are unintended or mistimed. That means that the preconception care provided by the Gabby System presents an opportunity to intervene during a critical window.

“The point of Gabby is not to replace the provider, but to facilitate conversation and fill in the gaps in the clinical encounter,” Yinusa-Nyahkoon says. It empowers women and “provides them with evidence-based information to get them thinking about their health or potential questions they could ask providers.”

When the program first launched, the Gabby team recruited Black women who were healthcare providers or students in health professions to test the system. “We really needed someone with some perspective about health to give us concrete information about what to add, what to fix, and how to tweak it,” Yinusa-Nyahkoon says.

Gabby—which was first created by Brian Jack, a BU School of Medicine professor of family medicine, and collaborators at BU School of Medicine and BU’s teaching hospital, Boston Medical Center, as well as researchers from the Relational Agents Group at Northeastern University’s Khoury College of Computer Sciences—is now being implemented in 12 urban and rural communities across the United States.

“One of the key strengths of Gabby is how comprehensive it is,” says Kylie Woodall (Sargent’21), an occupational therapy doctoral student on Yinusa-Nyahkoon’s research team. “There’s over 100 different factors that it can assess for, and then it has the ability to figure out which factors may be most relevant.”

The healthcare field needs “to recognize that anti-Black racism, not race, is the driving factor behind these health inequities and that this health crisis cannot be addressed without critically working to examine and dismantle racism and bias in healthcare and society at large,” says Woodall.

“A huge contributing factor is a lifetime of stress and just the burden, to be very frank, of being Black in America,” Yinusa-Nyahkoon says. “That just weighs on the body’s system and unfortunately affects birth outcomes.”

This complex problem even extends across income and education levels. “Recent data tell us that the worst stats are of Black women who have a master’s degree or higher, which negates the argument that it’s just a socioeconomic issue,” she says.

Yinusa-Nyahkoon’s interest in this research is, in part, personal. “As a woman who identifies as Black and has given birth four times, I feel the burden and I felt the pressure every time because I knew my outcome was never supposed to be good,” she says. “I would like all of us, in light of COVID-19, in light of Black Lives Matter, to actively demonstrate that, from the womb, Black lives do matter. We all need to work toward creating equitable outcomes.”

This story was adapted from “Closing the Gap,” originally published in Inside Sargent.