Dr. Rebecca Delafield Launches Maternal Health Study in Native Hawaiian and Pacific Islanders

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Dr. Rebecca Delafield was born in Saipan, the island capital of the Commonwealth of the Northern Mariana Islands. She moved away when she was a toddler but returned often to visit her father and her large extended Chamorro family. She remembers one uncle in particular who provided her encouragement she would take through the rest of her life.

“He would always ask about my education, ‘Becky, tell me, what are you studying?’” she recalled. “And the funny thing was that no matter what I said, he would always say, “Good, we need that here.”

“At one point, I think I said I wanted to be a filmmaker and he had the same response, ‘Good, we need that here.’” It was then that I realized, he wasn’t asking me about my aspirations. He was telling me my purpose.” Delafield said. “He was saying whatever I do, it should have a relationship with my community and meet the needs of my community.”

Years later, Dr. Delafield is on the verge of filling a much-needed void in health research for Native Hawaiians and Pacific Islanders. She was recently awarded a National Institutes of Health research training and career development grant (K-01) from the National Institute on Minority Health and Health Disparities to help her advance her research career. This 5-year grant will fund research training, as well as support Dr. Delafield’s investigation into severe maternal morbidity and the maternity care experiences of Native Hawaiians and Pacific Islanders.

Severe maternal morbidities are the “unexpected outcomes of labor and delivery that result in significant short- or long-term consequences to a woman’s health.” [1] Data suggests that for every maternal death, 70 -100 people experience a severe maternal morbidity. [2,3] “These include events like kidney failure, eclampsia, or infection, that happen during labor and delivery” she said.

While both maternal mortality and morbidity are relatively rare, they are largely preventable and there are documented disparities by race and ethnicity. When Dr. Delafield was writing her grant proposal, there was no federal report of maternal mortality among Native Hawaiian and Pacific Islanders. “The fact that we didn’t have this major statistic available for our Native Hawaiian and Pacific Islander population, one of the five federally recognized race categories, was shocking,” she said. Then, in May, while her grant was under review, the CDC published data showing that non-Hispanic Native Hawaiian and Pacific Islanders had the highest pregnancy-related mortality ratio relative to any other racial/ethnic group.[4]

Native Hawaiian and Pacific Islander major maternal health outcomes have been largely invisible to the public due, in part, to aggregation of data with the Asian race category. “Unfortunately, often when data is disaggregated, results suggest that Native Hawaiians and Pacific Islanders have risk factors for potential adverse events during pregnancy,” she said. “For example, Native Hawaiians and Pacific Islanders, compared to other racial groups, are the least likely to enter prenatal care early in their pregnancy, and they’re most likely to get no prenatal care,” she said.

“I think it’s not just about access to care, it’s about the relationship with health care.” Dr. Delafield will also be surveying 300 Native Hawaiian and Pacific Islander women about their experiences with health care during their pregnancy and delivery. “We’re trying to understand that relationship better, in order to find ways to improve it.”

During the grant period, she will work with community partners to disseminate her findings and receive additional training on research communication to help her effectively and appropriately share her research.

“I don’t want community members to have to search or just read it in a scientific journal. Part of the grant is focused on learning how to convey my research in a digestible way,” she said. “I want my research to touch them and have it mean something because that’s how we’re going to initiate change.”

Sparking change and making a difference in her community is what Dr. Delafield’s uncle challenged her to do, and she’s hoping that purpose will be reflected in her work on this project.

“The big win for me would be to take the information I’m learning and then see it applied,” she said. Ultimately, my long-term goal is to identify multilevel targets for a community-partnered intervention that will address policies, institutional practices, and behaviors. I am hopeful that with that type of approach, we could make a measurable difference.”