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Maternal-child health researchers offer their insights

Recently, the Center for Global Health and Infectious Disease at Washington University in St. Louis contacted some of the presenters at the 2014 CGHID conference to gain a deeper insight into their experiences in the field of maternal/child health. Here is what we learned:

Describe your career path a bit. What drew you to the field of maternal/child health?

Since 1997 I have been based in Uganda at the Uganda Virus Research Institute. I became interested in why bacilli Calmette-Guerin (BCG) immunization does not work well in tropical latitudes, and the possibility that this might be related to maternal worm infections and other early life exposures. Finding out the reasons for this may be very important not just for effective implementation of BCG, but also for effective implementation of any new tuberculosis vaccines.

Margaret K. Hostetter, MD
I trained in pediatric infectious diseases at Boston Children’s from 1978-80; with colleagues at the University of Minnesota in the mid-1980s, we established a clinic for internationally adopted children that attuned me to issues in global child health. I came to Cincinnati Children’s in 2010 and was inspired by the research in prevention of preterm birth and the immunology of pregnancy.

Amanda L. Lewis, PhD
I trained as a basic scientist in microbiology and spent many of my early years as a scientist unraveling how the pathogen Group B Streptococcus, a vaginal bacterium that can cause life-threatening newborn infections, synthesizes and utilizes its thick polysaccharide capsule to evade immune responses. I started my first faculty position here at Washington University a little over four years ago.

It was during my first year that I decided to take the academic risk of moving outside my comfort zone of basic science and venture into the field of translational medicine, and specifically, the role of the vaginal microbiota in women’s genitourinary health. I did this because it seemed that while there is a lot of valuable correlation-based clinical research in this area, there isn’t much known about the basic mechanisms of how bacterial species within the vaginal microbiota can encourage risk of other infections. The three most common urogenital infections in women are vaginal yeast infections, urinary tract infections and bacterial vaginosis. I find it fascinating and a bit sad that most women have never heard of the last one, bacterial vaginosis, even though it affects a lot of us (estimated at least 30 percent of women in the U.S.) and is associated with a wide variety of adverse health outcomes.

I found myself drawn to this field because virtually nothing is known about how bacteria that commonly live in the vagina (during bacterial vaginosis) gain access to the tissues of the uterus to cause infections that threaten pregnancy. I am also drawn to this field because I see amazing opportunities to help women. I believe passionately that if we can unravel the processes required for vaginal bacteria to invade the uterus, we have a good chance of being able to target these processes of invasion before they occur. This kind of anti-virulence approach might be particularly effective in the context of urogenital infections that are highly recurrent, often due to various mechanisms of antibiotic resistance.

What do you feel are the most pressing global issues today in the field of maternal/child health? Why?

(AL): Clearly, there are many pressing global issues in maternal-child health. In my mind, there is no greater need than the empowerment of girls and women by improving their access to education, contraception and basic health-care services in pregnancy.

(AL): To bring life into this world is to risk your own life, and there are unfortunately too many preventable factors that contribute to this risk. One of the past presidents of the International Federation of Obstetricians and Gynecologists, Mahmoud Fathalla, wrote, “Women are not dying of untreatable diseases. They are dying because societies have yet to make the decision that their lives are worth saving.” Others have made the observation that there is a strong correlation between societies with high maternal mortality and the marginalization of women in those societies. Poverty is clearly a contributor to the problem of high maternal mortality; however, the World Bank has noted that even very poor countries like Sri Lanka have made great strides in reducing maternal mortality, stating in their 2003 report that “maternal mortality can be halved in developing countries every seven to 10 years… regardless of income level and growth rate.”

(AL): Preterm birth, the birth of a fetus before 37 weeks of gestation, is another huge problem recently highlighted in the Born Too Soon report, a global collaboration between the March of Dimes Foundation, Save the Children and the World Health Organization (just to name a few of the nearly 50 organizations that made the report possible). Preterm birth and the health complications that arise due to preterm birth are estimated to kill over 1 million newborns each year – that makes it the second leading cause of death in children under 5 (after pneumonia). Infection is a common cause of preterm birth and potentially one of the more preventable causes of this outcome.

Although things are (slowly) changing, it seems as though leadership positions in the maternal/child health field are typically still dominated by men. Do you agree? If so, why do you think this is? What can/should we do about it?

(MH): The percentage of women in medical school classes did not rise above 45 percent until 2000. And even when one enters medical school, it will still require 25 years to reach full professor (with medical school, residency, fellowship and transition from assistant to full professor). Thus, given this type of 25-year career arc, we might not expect to see gender parity in top leadership positions until 2025 or later. We can of course try to influence timing and pipeline by ensuring that we recruit, train and retain outstanding women in those medical disciplines that have a major interface with maternal and child health.

(AL): The relative lack of women in leadership positions in the area of maternal/child health is not unlike many other STEM fields. My personal feeling is that access to maternity leave, quality childcare and flexible working conditions is key to the retention of women in these fields. Unfortunately, it seems institutions often fail in providing these necessary things to women during their most fertile years, before they can achieve a faculty title.