Jasmine Johnson, MD, third-year Maternal-Fetal Medicine fellow and clinical instructor in the UNC Department of Obstetrics and Gynecology, dedicates her research efforts on Black maternal health disparities and quality improvement efforts to reduce maternal mortality and morbidity.
Practicing medicine was in Jasmine Johnson’s bloodline. With her dad being a urologist, Johnson, a Detroit native, knew pretty quickly what career she wanted to pursue.
“I was introduced to medicine at a really early age and always knew I wanted to be a doctor, but I wasn’t sure what type of medicine I wanted to practice,” Johnson says. “Then, when I went to college, I was introduced to health disparities and how the root cause of many of those disparities, racism, bleeds into education, neighborhood opportunity, the carceral system, and it can all impact the trajectory of one’s life just from the color of their skin.”
During her senior year at the University of Michigan, Johnson had her son Nathan, but still pursued a medical degree at Indiana University School of Medicine. Having a child during medical school inspired her to chronicle it in her blog, The Mrs. The Mommy. The M.D.
“In medical school. I loved all of my rotations, but I felt this pull toward OB/GYN,” Johnson says. “While pregnant with my son, I had this wonderful Black, female obstetrician who supported me during that emotional and crazy time. She was more than a physician for me. In the back of my mind, I always thought that women’s health was where I should be.
Her rotations also included being on the Maternal-Fetal Medicine service, where she learned about complex high-risk pregnancy and post-partum medical conditions. Johnson completed residency training in obstetrics and gynecology at UNC-Chapel Hill, and is currently a Maternal-Fetal Medicine Fellow in the department. During her fellowship, Johnson has done extensive research on health disparities and inequities within the obstetric population. She is also interested in quality improvement efforts to reduce maternal mortality and severe maternal morbidity. Johnson says now is the time to look at solutions for eliminating the disparities we see in the healthcare system for Black women.
“As I move through fellowship and into my career, I want to continue to be a social justice minded MFM – practicing medicine but also doing health disparities research. I want to push my social justice platform further and make sure we’re advocating for Black women and using the evidence to back it up,” Johnson says.
In 2018, preterm birth affected 1 of every 10 infants born in the United States, according to the Centers for Disease Control and Prevention. Additionally, racial and ethnic differences in preterm birth rates also increased. In 2018, the rate of preterm birth among African-American women (14%) was about 50 percent higher than the rate of preterm birth among white women (9%). One argument for the disparity was sociodemographic differences between racial groups. But Dr. Johnson, first author in a study published in the American Journal of Obstetrics and Gynecology, found evidence that racial disparities in premature births persisted even among women of high socioeconomic status in the United States.
The study examined more than 2.1 million birth certificates from 2015-2017 from the National Vital Statistics System. All women were grouped by their self-reported race: white, black, or mixed. All women had at least 15 years of education, private health insurance, resources for prenatal care, and did not receive government assistance. Results from the study concluded at < 37 weeks, 9.9 percent of black women and 6.0 percent of mixed-race women delivered preterm as compared to 5.0 percent of white women. Similar disparities also persisted for earlier preterm births.
“That tells me that we can’t blame Black women for their health outcomes,” Johnson said. “Even when we look at women who are of similar socioeconomic background, black women still do not do as well. We need to be more creative in our solutions. Within the walls of the hospital we need to provide equitable care and train ourselves in biases. There’s so much that contributes to a person’s health outside of the hospital, too, and we’re finally talking about that, which makes me hopeful for the future.”
The CDC says Black, American Indian, and Alaska Native women are two to three times more likely to die from pregnancy-related causes than white women. It also says this disparity increases with age. Pregnancy-related death per 100,000 live births for Black and American Indian and Alaska Native women older than 30 was four to five times as high as it was for white women. Dr. Johnson says racism is a contributing factor to these disparities.
“What we’ve been learning over the past 10 years is if you look into the medical literature, medical problems in and out of obstetrics, you’ll find over and over again “Black race is a risk factor.” There is nothing biologically or inherently wrong with us as Black women that explains the reason why we have higher maternal mortality rates or why we have higher preterm birth rates. Racism is the risk factor,” said Johnson.
“We need to look at how race impacts care, whether that’s discrimination or access to care related to structural and societal racism that puts certain groups at risk to not receive the best services or resources that patients need to have for their health.”
To help strategize against racial inequities, Johnson says UNC’s OBGYN department is working with the Alliance for Innovation on Maternal Health (AIM), a national data-driven maternal safety and quality improvement initiative, to help improve safety and successful outcomes for all pregnant mothers. The initiative will include patient bundles, which are tools to help achieve best practices and standardize care for all patients. Johnson also says education and communication on disparities needs to become a standard in the medical curriculum for future medical professionals.
“That’s how we’re going to change outcomes, because medical students, undergrad students, and residents are all watching us and our behaviors,” she says. “We need to train our providers on addressing explicit and implicit biases, and how to identify their bias so that a person can take intentional efforts to overcome these issues. We also need to work on timely training in relation to the racial tensions in our country, and what we can do help improve our patients’ health and wellbeing.”
To continue to fight against racial inequality Johnson plans to continue her research on racial disparities in preterm birth outcomes, racial disparities in post-cesarean section pain management, and how implicit bias has negative association on national perinatal outcomes. Dr. Johnson currently serves on the Society for Maternal Fetal Medicine – Health Policy and Advocacy Committee, and co-chairs the Diversity Task Force for the department of Obstetrics and Gynecology at UNC.
“I am ready to shift gears from calling out the problem to solving the problem. We know that Black women have barriers to having the same outcomes that white women have. I want to be one of the people helping to change the statistics we see. It’s so important for us to see color when it comes to research, if we don’t track outcomes by race then we won’t see the problem,” Johnson said.
Jasmine Johnson, MD, a Maternal-Fetal Medicine Fellow in the UNC Department of Obstetrics and Gynecology, started a blog – The Mrs. The Mommy. The M.D. – a platform that she started as a resource for students, including mothers, who are considering medical school, looking for advice on residency, and deciding on a fellowship program. The blog is also a peek into Johnson’s life as a wife and mother of two children.
Written by Brittany Phillips, UNC Health Communications Specialist