Ndidiamaka Amutah

• PhD, MPH, CHES
• Professor (Associate) at Tufts University

Background Black-White inequities in severe maternal morbidity in the United States are extreme and growing. Maternal safety bundles (MSBs) have been associated with closing racial equity gaps in maternal health in some states. The objective of this study was to explore clinician perspective and experiences of implementing an Equity maternal safety...

Food insecurity disproportionately affects Black households in the United States (US) and is linked to adverse perinatal health outcomes. Addressing food insecurity is crucial for improving maternal and infant health outcomes, especially among Black mothers. This scoping review explores the impact of food insecurity and low food access (i.e., food...

Purpose To demonstrate the process and results of an equity analysis of a reproductive health association. Description A series of quantitative surveys and qualitative interviews were conducted with employees of Planned Parenthood League of Massachusetts (PPLM), assessing different aspects of equity. Amaka Consulting and Evaluation Services, LLC,...

Importance Pregnant individuals who repeatedly use emergency care during pregnancy represent a population who could be disproportionately vulnerable to harm, including severe maternal morbidity (SMM). Objective To explore patterns of unscheduled care visits during pregnancy and ascertain its association with SMM at the time of birth. Design, Sett...

This manuscript is based on Project INSPIRE: Improving New Somerville Parent & Infant Resiliency & Engagement, a healthcare and early childcare sector collaboration between: 1) the Center for Black Maternal Health and Reproductive Justice (CBMHRJ) at Tufts University School of Medicine in Boston, Massachusetts; 2) MARCH: Maternal Advocacy and Resea...

Every day, two or three women die because of pregnancy or childbirth. Nearly 80% of these deaths are preventable. These outcomes disproportionately impact racialized populations, including Black and Indigenous women, who are two to three times more likely to die. The Practical Playbook III: Working Together to Improve Maternal Health is a guide for...

The growing restrictive abortion policies nationwide and the Supreme Court decision on Dobbs v. Jackson Women’s Health Organization place increasing barriers to abortion access in the United States. These restrictions disproportionately affect low-income people of color, immigrants, and non-English speakers, and have the potential to exacerbate alr...

OBJECTIVE To examine demographic and clinical precursors to pregnancy-associated deaths overall and when pregnancy-related deaths are excluded. METHODS We conducted a retrospective cohort study based on a Massachusetts population–based data system linking data from live birth and fetal death certificates to corresponding delivery hospital discharg...

Objective To examine the smoking patterns of women who experienced stressful life events and the impact of racial disparities on the relationship between stressful life events, and prenatal/ postpartum smoking. Methods The study analyzed data from the Pregnancy Risk Assessment Monitoring System Phase 8 (2016–2018) survey across five states (CT, LA...

OBJECTIVE The PNQIN (Perinatal-Neonatal Quality Improvement Network of Massachusetts) sought to adapt the Reduction of Peripartum Racial and Ethnic Disparities Conceptual Framework and Maternal Safety Consensus Bundle by selecting and defining measures to create a bundle to address maternal health inequities in Massachusetts. This study describes t...

Background: Severe maternal morbidity (SMM) includes unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman's health. We used a statewide longitudinally linked database to examine hospitalization during and prior to pregnancy for birthing people with SMM at delivery. Objective: To examine...

INTRODUCTION Measuring patient experience is core to understanding and addressing inequities in obstetric care quality. METHODS People who gave birth at one of five hospitals in Massachusetts and identified as non-Hispanic Black (NHB) or non-Hispanic White (NHW) were invited to complete a structured survey 7–16 weeks postpartum, from February to S...

Purpose: Exposure to stress during the prenatal period is often associated with adverse maternal and neonatal health outcomes and is increasing in prevalence in the United States. Health care providers play a crucial role in addressing and mitigating this stress, but there is a lack of consensus in effective interventions. This review evaluates th...

Parents play an important role in delaying adolescent tobacco use, particularly through role modeling, parent-child relationships, and monitoring. Although these intrafamilial processes are relatively well documented, few studies have examined them among urban, Black mother-son dyads. Using data from 526 mothers and their adolescent sons living in...

In 2018 Blacks/African Americans made up 13% of the female population but accounted for 58% of diagnoses of human immunodeficiency virus (HIV) infection among females.1 Studies show that women have always been underrepresented in HIV/acquired immune deficiency syndrome (AIDS) studies, however, the coronavirus disease-2019 (COVID-19) pandemic has fu...

For HIV-positive African Americans, the mistrust of medical providers due to anticipation of unequal treatment care, prejudice, and bias can become a major deterrent to medication and treatment adherence. Although programs and services incorporate strategies to improve patient–provider relationships, a deeper understanding of their healthcare exper...

It is estimated that 50,000–60,000 pregnant people in the United States (US) experience severe maternal morbidity (SMM). SMM includes life-threatening conditions, such as acute myocardial infarction, acute renal failure, amniotic fluid embolism, disseminated intravascular coagulation, or sepsis. Prior research has identified both rising rates throu...

Background As awareness of perinatal health disparities grows, many birthing people of color are seeking racially and/or culturally concordant providers. We described preferences for, and perceptions of, racial and/or cultural concordance and cultural competence in the context of the doula–client relationship. Methods Seven focus group discussions...

This qualitative study examines how the “Strong Black Woman” (SBW) label can have potentially negative health effects for African American/Black women that contribute to eating disorders. This study addresses the gap in literature on racial disparities that are present in understanding eating disorders that contribute to obesity and obesityrelated...

While Black girls and women are disproportionately impacted by sexual health disparities, there continues to be an overwhelming focus on individual risk behaviors within prevention initiatives, which offers a fragmented narrative of the multidimensional nature of risk and plausibly limits effectiveness of prevention programs and attenuates reductio...

Low literacy levels in Black women with HIV (WWH) have been shown to amplify pre-existing health disparities and sequelae of non-adherence to health-related guidance. Wisdom Matters is a community-based participatory research program with an aim of improving health literacy in populations of Black WWH and assessing the existing knowledge, attitudes...

Background. Due to their intersecting racial identity and gender identity, Black women are characterized by stigmatizing race-based sexual stereotypes (RBSS) that may contribute to persistent, disproportionately high rates of adverse sexual and reproductive health outcomes. RBSS are sociocognitive structures that shape Black women’s social behavior...

Background: Daughters of HIV positive women are often exposed to similar factors that placed their mothers at risk of HIV. Compared to women of other racial/ethnic groups, African American women have disproportionately higher rates of HIV/AIDS. This pilot study examines the relationship between African American HIV positive mothers and their daught...

Black women living with HIV (BWLWH) contend with injuries of injustice, which manifest in restricted reproductive autonomy and decision-making power in social and medical settings. Mitigating threats to reproductive autonomy calls for innovations that consider patients' needs and offer insights on how historically situated marginalization influence...

Introduction Prior research has found that some preconception health risks are more prevalent among women in historically minoritized racial and ethnic groups. Preconception health risks are also increased among women with disabilities. Risks could be even greater among women who both have a disability and belong to a minoritized racial or ethnic g...

HIV incidence and prevalence rates in emergency departments (EDs) around the nation warrant strategies to protect and sustain the HIV negative status of persons who are at risk for HIV. The ED provides a rare opportunity to serve as a vehicle for connecting pre‐exposure prophylaxis (PrEP)‐eligible patients with clinical settings such as an ED that...

Uptake of pre-exposure prophylaxis (PrEP) among Black women living in the US is suboptimal. We sought to determine the association between HIV-related medical mistrust (or belief in HIV conspiracy theories) and willingness to use PrEP among Black women. We analyzed data from the 2016 National Survey on HIV in the Black Community (NSHBC), a national...

Background: This study examined agreement between partners on perceptions of relationship quality and its impact on later (STI) diagnosis in a sample of pregnant (AYA) couples. Methods: Two hundred and ninety-six AYA couples completed structured surveys on relationship quality (satisfaction, cohesion, consensus, affectional expression) and STI d...

Purpose: Faculty from different racial and ethnic backgrounds developed and piloted an anti-racism curriculum initially designed to help medical students work more effectively with patients of color. Learning objectives included developing stronger therapeutic relationships, addressing the effects of structural racism in the lives of patients, and...

The aim of Project THANKS (Turning HIV/AIDS into Knowledge for Sisters) was to provide resources for African American women living with a dual diagnosis of HIV and associated comorbidities such as a chronic illness, and substance use disorder. HIV self-management is viewed within a larger context that addresses HIV and comorbidities concurrently. P...

Objectives To examine nativity-based differences in 3 cardiovascular biomarkers commonly used to assess cardiovascular dysregulation.Methods Data was pooled from the 2001–2016 National Health and Nutrition Examination Survey to compare biomarker risk scores for the US-born (n = 4693) and foreign-born (n = 2968) Black adults. We used multivariable-a...

Abstract Background In addition to its health and nutritional benefits, breastfeeding can save low-income, food insecure mothers the cost of infant formula so that money can be spent on food and other necessities. Yet breastfeeding may exacerbate food insecurity by negatively affecting maternal employment. The relationship between food insecurity a...

The current qualitative study explores the experiences of Black mothers who prepare their sons for potential police encounters. Police presence in the Black community has historically elicited feelings of mistrust and fear among Black Americans, and those sentiments resonate today. The discrete incidents of police violence in the United States have...

Little is known about pregnancy outcomes of black immigrant women to the US. We surveyed 447 black women post-partum in two hospitals in Newark, NJ. Length of gestation was obtained from medical records. Covariates and information on immigration were collected by in-person interview. Risks ratios for preterm birth (< 37 weeks) comparing immigrant t...

A growing number of studies have demonstrated a strong association between reproductive coercion and unintended pregnancy among adolescent and young adult females. However, few studies have examined how a pregnancy resulting from an experience of reproductive coercion affects parenting and the child's development. To address this gap in the current...

Background: African refugee women in the United States are at risk of poor reproductive health outcomes; however, examination of reproductive health outcomes in this population remains inadequate. We compared: (1) prepregnancy health and prenatal behavior; (2) prenatal history and prenatal care utilization; and (3) labor and birth outcomes between...

This qualitative study examines the role of communication among African American mothers living with HIV and their daughters in HIV prevention. Multiple themes emerged from our analysis of semistructured interviews with mothers (n = 15), and their adult daughters, (n = 15) such as perceptions of HIV risk communication, HIV/AIDS knowledge, attitudes...

Project THANKS, (Turning HIV/AIDS into Knowledge for Sisters), is an evidence-based intervention that utilizes a community-based participatory and empowerment building approach for African American female substance abusers living with HIV and other chronic diseases. This qualitative study sought to gain insight from women living with HIV on how to...

Social inequalities are at the heart of disparities in sexual health outcomes among African American and Latino/a adolescents living in the United States. Schools are typically the largest and primary context in youth development. School characteristics such as peer and teacher discrimination and school performance were examined to determine whethe...

AIMS AND SCOPE Clinical Medicine Insights: Women’s Health is an international, open-access, peer-reviewed journal which considers manuscripts on all aspects of the diagnosis, management, and prevention of disorders specific to women, in addition to related genetic, pathophysiological, and epidemiological topics. Clinical Medicine Insights: Women’s...

Background and Objectives Despite advances in modern healthcare, Traditional Birth Attendants (TBA) have continued to be heavily utilized in rural communities in Nigeria. Major disparities in maternal health care in Nigeria remain present despite the goal of the United Nations Millennium Development Goal to reduce maternal mortality by 2015. The ob...

Objectives Black women disproportionately share the distribution of risk factors for physical and mental illnesses. The goal of this study was to examine the sociodemographic and health correlates of major depressive disorder (MDD) symptoms among black women. Methods Pooled data from the 2005–2010 National Health and Nutrition Examination Survey (N...

Children who come into contact with the child welfare system are at greater risk of experiencing internalizing and externalizing behaviors. This secondary analysis of the National Survey of Child and Adolescent Well-Being explored how caregiver characteristics and behaviors, and caregiver–child closeness influence these outcomes over time. The fina...

Background: Studies of neighborhood racial composition or neighborhood poverty in association with pregnancy-related weight are limited. Prior studies of neighborhood racial density and poverty has been in association with adverse birth outcomes and suggest that neighborhoods with high rates of poverty and racial composition of black residents are...

Adolescent children of incarcerated mothers (ACIM) are typically left in the care of adults (primary caregivers) who play a crucial role in children’s care and guidance, as well as in the facilitation of contact and communication with incarcerated mothers. The purpose of this study was to explore the nature of relationships and communication among...

The purpose of this qualitative secondary data analysis is to examine the major influencers on mothers with HIV in their childbearing decisions, as well as how those influencers shape conversations with clinicians and health-care providers regarding HIV treatment and prevention. The original study gained insight into the reproductive decision-makin...

According to the Joint United Nations Programme on HIV/AIDS (UNAIDS), as of 2013, there were approximately 16 million women and 3.2 million children living with HIV worldwide. Complex issues triggered by HIV infection – including illness, poverty, stigma, and secrecy – reflect a need to understand HIV in the family setting. Given the primary role f...

One of the many reasons for smoking litigation against public health agencies such as a health department is due in part to the gap between public health education and knowledge of the laws by those who are regulated by these policies. This research study examined the effectiveness of public health instruction and curriculum from the New York City...

African-American men in Baltimore, MD, participated in a focus group on issues relating to their health and quality of life. Specific topics in this pilot study included: community perceptions, the role of men in family planning, navigating the healthcare system, and overall perspective on life as experienced within an urban context. The participan...

Background: In 1997, the NJ Department of Health launched a statewide awareness campaign focusing on racial disparities in perinatal outcomes, including a “Black Infants, Better Survival” website and a requirement that physicians obtain cultural competency education, as a condition of licensure. Funding was dedicated to interventions that reduced t...

Background: Epidemiologic evidence is increasing on the importance of the social determinants of preterm birth (PTB) among women of color, but it is unknown how this evidence is perceived by providers. We examined providers’ perceptions of racism, poverty, and living in a poor neighborhood as contributors to PTB among African Americans. Methods:...

Introduction: In New Jersey, African American mothers, ages 18 and over, accounted for 63% of the new HIV cases among all females.The context of the mother-daughter relationship with regards to communication about sex is a potential opportunity for prevention of the transmission of HIV. African American female adolescents also report more discussio...

Introduction: Substance abusers with HIV are living longer as a result of advances in treatment but also face an increased risk for chronic diseases. This pilot study sought to explain how Black and Hispanic female substance abusers faced with a dual diagnosis of HIV and a chronic illness defined and conceptualized their own health; and to identify...

Infant mortality is the most widely used indicator of a nation's health status and is associated with a plethora of maternal and socioeconomic factors. Although the association between young and old maternal age and the risk of infant mortality is well established, the link between paternal age and birth outcomes has received far less attention. Th...

HIV-positive individuals are living longer today as a result of continuing advances in treatment but are also facing an increased risk for chronic diseases such as diabetes, and hypertension. These conditions result in a larger burden of hospitalization, outpatient, and emergency room visits. Impoverished African American women may represent an esp...

Background: Data from the Center for American progress state that Black immigrants are a significant group in the United Statesmore than 3 million people comprising 8 percent of the U.S. foreign-born population. Additionally, in 2011 black immigrants had the highest unemployment rate12.5 percentof any foreign-born group in the United States. Thus...

Substance abusers with HIV are living longer as a result of continuing advances in treatment but are also facing an increased risk for chronic diseases. These conditions add to their health concerns resulting in a larger burden of hospitalization, outpatient, and emergency room visits. Impoverished ethnic minority women may represent an especially...

The disproportionately high rates of adverse health outcomes among Black children represent an important issue in the United States. Black children are more likely to die within the first year of life. Moreover, previous research has shown substantial racial and socioeconomic disparities in US breastfeeding rates. However, the role of immigrant sta...

We explored the relationship between neighborhood socioeconomic disadvantage (NSED) and gestational weight gain and loss and if the association differed by race. A census tract level NSED index (categorized as low, mid-low, mid-high, and high) was generated from 12 measures from the 2000 US Census data. Gestational weight gain and other individual-...