Delivery of Care

What to expect when you are expecting

Dr. Nicole Alexander-Scott, director of the R.I. Department of Health, shares her perspective on maternal health as an expecting mom

Photo courtesy of the R.I. Department of Health

With Dr. Nicole Alexander-Scott delivering a flu shot, Steve Klamkin of WPRO pulls off the extremely rare vaccination selfie, as part of the the R.I. Department of Health’s annual flu vaccine kickoff in 2017.

By Richard Asinof
Posted 1/17/22
Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health, shares her perspective on the importance of maternal health as an expectant mom.
Will Rhode Island, following up on the suggestion of Dr. Mona Hanna-Attisha, a pediatrician from Flint, Mich., create a nutrition prescription program for mothers and their young families, enabling them to purchase fresh fruits and vegetables? What kinds of interventions are available to help with maternal depression, given that in 2018, nearly one-third of the mothers who gave birth had a documented history of treatment for maternal depression? Does there need to be different strategies to treat mothers with substance use disorders, such as focusing on recovery housing for mothers with young children?
The demographics of Rhode Island point to three emerging trends: a falling birthrate; a growing “old old” population, people who are 85 years of age or older; and the reality that children of color will soon become the majority of children in the state.
Translated, in 2017, 55 percent of kids ages 0-4 were children of color, while 89 percent of the over-65 population was non-Hispanic white, as detailed on Page 16 of the 2019 Rhode Island Kids Count Factbook. It is a stark divide.
Where that data hasn’t necessarily been translated yet is in the way that the R.I. General Assembly struggles to makes decisions about investments, in how it decides between consumption-oriented and investment-oriented spending.
If we want to decrease the educational achievement gap in Rhode Island, we need to invest in the creation of more affordable, safe housing. If we want to decrease future health care costs, we need to invest in better prevention programs for chronic diseases and the removal of toxic environmental threats such as lead. If we want healthier children, we need to invest in reducing the risk factors for infants around equity.
To ensure a healthy, prosperous future for all of Rhode Island’s children, it requires an investment strategy that recognizes such values.


[Editor’s Note: In the wake of the abrupt resignation of Dr. Nicole Alexander-Scott as director of the R.I. Department of Health, ConvergenceRI is republishing a number of stories which feature Dr. Alexander-Scott during her seven-year stint as the leader of the state’s health agency. In this story from April of 2019, Dr. Alexander-Scott shared her views on maternal health from the perspective of being an expectant mother.]

PROVIDENCE – In her weekly wellness check in, which was broadcast on April 16, 2019, Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health, spoke about maternal health, which she defined as “the health of a woman during pregnancy, during childbirth, and in the period after a baby is born.” [See link below to YouTube of the wellness check in.]

This topic, she continued, “ is near and dear to my heart, because I am expecting a little miracle of my own in just a couple of months.”

ConvergenceRI reached out to Alexander-Scott to ask her a number of questions related to maternal health and her own experiences. Here are her responses:

ConvergenceRI: Has being an expectant mother resulted in a new awareness around issues of maternal health?
ALEXANDER-SCOTT: I would not say that my experience has brought me a “new awareness” about maternal health, because it has been a major priority of mine for a long time.

Maternal health is such a telling indicator of the health of a community, and sadly, maternal health could be much better across the country, especially from a health equity standpoint, so this issue is a focus for most leaders in public health today.

However, this journey has certainly brought me a different perspective that is much more personalized, with a better understanding of the concerns and questions many women have experienced.

As an infectious disease physician for adults and children, I have had many difficult conversations with pregnant women about health issues, like the disproportionate risk of infant or maternal mortality among African Americans, regardless of socioeconomic status, or the transmission of infections such as certain bacteria, HIV, and the Zika virus.

The experience of being pregnant has given me a different perspective on how emotionally complex conversations about health can be when you are thinking about both your own health, and the health of another being.

ConvergenceRI: How important is it to create a supportive circle of friends, family and caregivers before, during and after the birth of a child?
ALEXANDER-SCOTT: It is incredibly important. Over these past several months I have been so blessed to receive love and support from my family, friends, co-workers, and a wonderful team of health care providers.

But it has also given me an opportunity to reflect on the fact that not everyone has the same support network or the same supportive environment, with access to the services needed, that I have.

The challenge for us in public health then becomes, despite that fact, how can we ensure that all mothers, families, and babies have an opportunity to be as healthy as possible – and to live in the healthiest community as possible.

Doing that means looking at the socioeconomic and environmental determinants of health, which are the factors where we live, work, eat, and go to school, and thinking about how they impact maternal and child health.

There is actually a lot of great work happening in Rhode Island in this area already. For example, our department’s Family Home Visiting Programs are out in the community providing support as community health workers doing education and helping with the many transitions in the lives of families before and after a pregnancy.

This is on top of all the great work being done by our WIC program, by our Health Equity Zones, and by our Maternal and Child Health program, which also co-leads the Rhode Island Task Force on Premature Birth.

ConvergenceRI: What are the areas where Rhode Island can improve upon the outcomes for maternal health, particularly with African American women?
ALEXANDER-SCOTT: Looking at the issue of maternal health and race, you are correct: disparities do exist, and they can be prevented.

These disparities are largely because of living conditions in people’s communities that require action beyond the individual to improve. Examples include: better access to healthy food; the availability of healthy housing; [access to] quality education; and the ability to get health care in a way that is responsive to someone’s culture and traditions.

And, of course, we have to be mindful of the fact that forces like discrimination in systems across the country are still very real. This is why it is so important that we shift the focus of our investments into the community. Despite all that we invest in clinical care in medical settings, 80 percent of our health outcomes are determined by community-level factors, such as the ones I’ve mentioned. One great example of how we are shifting these investments is Rhode Island’s Health Equity Zones.

There are additional areas where we can make improvements in the health of all pregnant and postpartum women in Rhode Island, regardless of race. For example, we have higher rates of pre-pregnancy obesity than we would like to see, and smoking is still sadly a concern.

And, of course, even though we have made some progress, we would like to bring down our rate of unintended pregnancy. We know that our communities are healthier when women and families have babies when they are ready.

ConvergenceRI: What have been some of the things that you have learned about what to know when you're expecting? For instance, things like wearing sensible footwear.
ALEXANDER-SCOTT: Having good footwear is certainly a must, especially while I am still recovering from a major hamstring injury. Besides that, one of the major things I have learned is how much I have to learn!

I have spent a good portion of my adult life learning in academic and clinical settings, but this is a whole different, wonderful type of learning, where I am benefiting from the wisdom of my community members, family members, and friends.

It has brought me a tremendous amount of humility, gratitude, and joy. And it has really affirmed for me how much we all depend on each other, and how important it is to stay connected to our community of support.

ConvergenceRI: How will the workspace at the R.I. Department of Health perhaps be changed to accommodate the needs of young mothers and their infants? Are their private breast-pumping facilities? Onsite daycare?
ALEXANDER-SCOTT: Staff at the R.I. Department of Health has been working for a long time to make our workspace as welcoming and accommodating as possible for people during various phases of life.

For example, we have a dedicated lactation room, and we now have all-access, gender-neutral restrooms that accommodate families.

Ultimately, the thing that I am most proud of is our work at R.I. Department of Health to build a culture in which all women, and all people, feel valued. I always refer to my co-workers at the Department as the members of my RIDOH family. That’s because of the great lengths that we go to support each other, not just as colleagues but as people who we genuinely care about.


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