Interviews with Stakeholders

In our research, we interviewed 16 women from Avondale, 14 who were mothers, 2 fathers, and 19 stakeholders, including medical professionals and leaders from community agencies. Below is a selection from the stakeholder interviews, which describes their perspectives on the issues of preterm birth in Avondale.


An Interview with Elizabeth Kelly, Obstetrician-Gynecologist, Faculty at the University of Cincinnati’s College of Medicine, Director of the Division of Community Women’s Health
This interview is a transcribed from a portion of an in-person interview with Dr. Elizabeth Kelly.

[Physicians often say] ‘You’re going to come for your appointments, you’re going to take your vitamins, and get your ultrasound.’... Instead of, ‘I’m going to come to you, and you’re going to tell me where you are, and I’m going to recommend things for you, and we’re going to find what works for you.’

Tell me a little about yourself.
My entire professional life has been working with vulnerable populations, of which women are one. As it started out, I was working with minority women, hispanic women primarily in the South Bronx, Appalachian women in Appalachia, and depending on the region in which I am working in Cincinnati and Hamilton county, African women, hispanic women, and we have an Appalachian population as well. I consider myself first a woman, so when people talk about the disparity [of premature birth and infant mortality], I look at it as a disparity for women and as well as a disparity for African American women.

Tell me about women as a vulnerable population.
Throughout my career, I have seen that women are treated as inferiors or seen as inferior, I don’t think women are treated as fair in the workplace, I don’t think women are generally respected for their voice across populations. And I’ve seen minority women treated were treated as fourth class citizens, which is why I chose to work with them. They were discriminated against because of their race or ethnicity, and maybe not more than they were discriminated against because they were women. Internally, I think that some women feel that they can’t do better. With African American women, they experience an undertone or blatant racism combined with generations of oppression that lead these women to be more vulnerable.

How does this vulnerability affect health outcomes?
I’ve seen a lot of women come in with a lot of negative body language–like “I don’t want to talk to you.” And when they see that I’m just here to hear you life story, I’m not here to judge you, I’m not here to tell you what to do, I’m not your mom–and that I’m here to work with you, not tell you what to do, it gets better. I think a lot of white physicians may come off as judgmental. I think there’s such a split between poor, black women and white healthcare providers who are usually in an upper socio-economic group, that women come in to the office very differently, less open.

And I think that a lot of white physicians try to place their values or how this woman is supposed to change her life to make it better. “You’re going to come for your appointments, you’re going to take your vitamins, and get your ultrasound. I’m going to put this on you.” Instead of, “I’m going to come to you, and you’re going to tell me where you are, and I’m going to recommend things for you, and we’re going to find what works for you.”

I think the reason the outcomes are the way they are is because there’s a lack of trust, but the lack of trust continues when patients come into the healthcare system and they don’t feel like that person understands them. And the provider doesn’t always know how to understand them.

 

An interview with Anita Brentley, Senior Specialist in Community Engagement for Every Child Succeeds and Cincinnati Children’s Hospital Medical Center
This interview is a transcribed from a portion of an in-person interview with Anita Brentley.

Mom needs the tools–a phone, transportation needs to be available. Mom needs a plan in place where she has established a routine, has schedules available to her. And these would start from Mom being a child, to when she’s ready to have a child.

Tell me a little about what you do.
I engage the community around early intervention, home visitation, working to improve the outcomes of first and second time mothers in several communities across the Tri-State.

What is the problem that women are facing?
One of the reasons I feel like I need to do this work is because I have been involved in the community for several years–at one of my first jobs at Cincinnati Children's, I recognized the need to engage mothers. I recognized the need to provide additional resources to mothers based on the conversations we would have.

The issue of health is one that has resonated with me for a very long time. Recognizing that it is one that there are gaps in the process of getting from point A to point B for our families. And those are huge gaps.

What are some examples of those gaps?
Just very simple things–or things we consider simple, like transportation. But some of those other gaps are deeply embedded in communities...we need to look at issues of isolation, we need to look at issues of social structure and social justice. We also need to look at empowering our moms to ask the right questions so they can support themselves and their child.

Can you tell me a little bit more about social structures? What does that mean?
It means a lot of things for me, but when I’m talking about the moms I’m looking at what is necessary for them to be good parents...Some moms have to figure out when to leave their home so they don’t have to be on the street with people who are doing things they shouldn’t be and this can cause them to miss a bus or an appointment. And that’s not something that resonates with a doctor or nurse when they finally get to that door.

So that whole attitude is set and moms are feeling defeated, even though they know they’re doing what they need to do. Sometimes they feel they’re looked down on, because they’re late for that appointment, but no one asks why. And then they’ll have to sit there, possibly with other children or cousins, for an extreme amount of time…This is where these gaps come from, with these families–when you set a tone that’s not positive, they’re not going to want to come back.

Imagine your average mom. If you were to redesign social structures to be in service in the way she lives, what would that look like that?
Mom needs the tools–a phone, transportation needs to be available. Mom needs a plan in place where she has established a routine, has schedules available to her. And these would start from Mom being a child, to when she’s ready to have a child. It would start with her education…getting into schools, completing her education, preparing herself for her life course.

 

An interview with Ozie Davis III, Executive Director of the Avondale Comprehensive Development Corporation
This interview is a transcribed from a portion of a phone interview with Ozie Davis III.

It’s a two way street. There’s always been a tall wall between the institutions and the community. And to climb that wall, it’s taken years and years to better those relationships on either side of that wall. It takes a lot to build trust.

Tell me a little bit about what you do, and ACDC’s mission.
We see ourselves as the neighborhood’s caremaker and caretaker. We coordinate, implement, or partner with people to better the situation of people here in Avondale. I count it a blessing to lead that charge because it is my home neighborhood. I am in a position to see what it might take [to make it better]. Our neighborhood is interesting in that it has all the assets, it just hasn’t realized them.

What do you mean by “it hasn’t realize those assets?”
Well, take infant mortality. We have one of the best children’s hospitals in the world, but such a high infant mortality rate. If we used those assets, we wouldn’t have that mortality rate. You could take advantage of the resources right here at your doorstep.

What’s preventing the neighborhood from using those resources?
It’s a two way street. There’s always been a tall wall between the institutions and the community. And to climb that wall, it’s taken years and years to better those relationships on either side of that wall. It takes a lot to build trust. Even when that wall comes tumbling down, there’s still a sense of: how do you educate those in the community that the resources are here, and how do you educate those in the institutions that going out will not injure you (laughs)?

How might we create shared value between institutions and people? How might we create the sense that lowering the rate of preterm births and infant mortality is in the best interest of everyone?
The first step in the hardest. It has to be shocking. People have to know that babies are dying. People don’t want to talk about that. We have to wake people up by delivering facts where they lie.

How do you reach the hard to reach people?
You got to be out there...You've got to go where people are. We have a saying around here, ‘Nobody’s hard to reach.’ If you’re on the streets, we’ll walk up to you. If you’re in the building, we’ll knock on the door. We work with corner stores to get our information out. There’s no stone we won’t turn over to talk to people in this neighborhood. I don’t think people are hard to reach. You can reach them, but they’re not trying to reach you. You have to go to people, and then there’s nothing you can do about their willingness, you have to leave the open door, and when they’re ready, they’ll come in.

If you could just snap your fingers and have whatever resources you needed, what would those resources be?
I need more positive black men. I need more positive black men to be role models to people in the neighborhood. That would be the first thing. The next thing would be, I need a more educated community, with jobs and GED’s.