Environmental impacts on women’s health disparities focus of workshop (Environmental Factor, June 2022)

Differences in women’s health that are influenced by exposures, socioeconomic factors, and racial disparities were the focus of “Environmental Impacts on Women’s Health Disparities and Reproductive Health,” an NIEHS virtual workshop held April 27-28.

Researchers, community partners, and scholars from across the country described how environmental stressors can affect maternal and fetal health outcomes and assessed the role of racial and ethnic disparities in exposures. They also discussed how to build authentic partnerships in disproportionately impacted communities, and they identified gaps and potential next steps in advancing environmental health disparities and women’s reproductive health research.

Compared with white women, Black women in the U.S. experience disproportionately higher rates of death related to pregnancy and childbirth, according to participants. Women of color are more likely be uninsured and face greater financial barriers to care, and they are less likely to have access to prenatal care. Attendees also noted that environmental exposures can compound disparities related to preventable conditions, such as type 2 diabetes and cardiovascular disease.

The NIEHS Environmental Health Disparities and Environmental Justice (EHD-EJ) Faculty sponsored the event, the second in a two-part series. The first workshop, held last December, focused on solutions to environmental racism through community partnerships.

From left, Darlene Dixon, D.V.M., Ph.D., and Melissa Smarr, Ph.D.

From left, event organizers Darlene Dixon, D.V.M., Ph.D., from the Mechanistic Toxicology Branch of the NIEHS Division of the National Toxicology Program, and Melissa Smarr, Ph.D., from the Population Health Branch of the Division of Extramural Research and Training, are two of the co-leads of the 70-plus member EHD-EJ Faculty. (Photo courtesy of Steve McCaw / NIEHS)

“Most shocking and inhumane”“

Of all the forms of inequality, injustice in health is the most shocking and inhumane,” Martin Luther King, Jr. said more than five decades ago. Erica E. Marsh, M.D., from the University of Michigan, shared that quote as part of her presentation on disparities in reproductive health.

A professor of obstetrics and gynecology at the University of Michigan Medical School and chief of the Division of Reproductive Endocrinology and Infertility, Marsh specializes in infertility and uterine fibroids, among other areas of study. (Photo courtesy of Erica Marsh)

“When we talk about inequality, we're really talking about an equal access to opportunities,” she said. “Equity is when we really are thoughtful and customize tools that identify and address the inequality that exists at baseline.”

Marsh noted that economic stability, neighborhood and physical environments, education, and access to nutritious food all drive health outcomes and intersect with race. Race is also a social and structural component of health, as is ethnicity. These matter in medicine because they can have bearing on a diagnosis a doctor may give to a patient, according to Marsh.

For example, endometriosis — a disorder in which uterine tissue grows outside of the uterus — was described in the middle 20th century as a disease of white women in a higher income bracket. Other women who arrived in the emergency room would have been more likely to be diagnosed with pelvic inflammatory disease.

The experience of racism and the resulting chronic stress drives differential health outcomes and ultimately inequities, from COVID-19 deaths to uterine fibroids, noted Marsh.

“Race and racism are factors that impact care,” she told attendees.

Epidemiology and improved health equity

Risk factors for negative health outcomes in disadvantaged groups are more numerous than in other groups, according to NIEHS grantee Tamarra James-Todd, Ph.D., from Harvard T.H. Chan School of Public Health.

James-Todd is an associate professor of reproductive and perinatal epidemiology at the Harvard T.H. Chan School of Public Health. She is also an associate epidemiologist in the Division of Women’s Health at Brigham and Women’s Hospital. (Photo courtesy of Tamarra James-Todd)

“The question really is, what can we do about that?” she said. “Why do they have a higher disease burden?”

Asking that question is key to building trust and developing sustainable interventions that affect policy, spur social change, and improve health, she noted.

Factors such as historic redlining (the practice of discriminatory mortgage lending practices), retailer redlining, food insecurity, home and gender roles, air and noise pollution, beauty norms, and types of work can result in environmental exposures that affect health.

Also, endocrine-disrupting chemicals — including pesticides, plasticizers, and flame retardants — are associated with adverse women’s health outcomes ranging from infertility to preterm birth, according to James-Todd. Her lab is investigating whether higher exposure to those chemicals creates differences in health outcomes.

According to James-Todd, a variety of approaches will be required to reduce environmental health disparities. Some examples include improving environmental health literacy and understanding the structural factors — workplace environments, public policy, and so forth — that can place people at increased risk of exposures.

Reproductive health disparities and the environment

Researchers from more than a dozen institutions presented on issues related to women’s reproductive health. In addition to Marsh and James-Todd, the following individuals offered their expertise during the workshop.

“Racial and Ethnic Disparities in Environmental Exposures and Reproductive Health Outcomes — What Do We Know and What Do We Need to Know?” by Michael Bloom, Ph.D. from George Mason University.
“Investigating the Interplay Between Environmental and Social Stressors on Maternal Reproductive Health,” by Carrie Breton, Sc.D., from the University of Southern California.
“Communities’ Observations to Inform Environmental Health Research in Northeastern British Columbia, Canada,” by Élyse Caron-Beaudoin, Ph.D., from the University of Toronto Scarborough.
“A Practical Approach to EleVATE Equity in Reproductive Health,” by Ebony Carter, M.D., from Washington University School of Medicine, St. Louis.
“Context Matters: The Disconnect Between Animal Models and the Complexity of the Human Environment,” by Deborah Cory-Slechta, Ph.D., from the University of Rochester Medical Center.
“Creating Authentic Partnerships Between the Columbia Center for Children’s Environmental Health (CCCEH) and Community Youth,” by Julie Herbstman, Ph.D., from Columbia University, and Yesibel Pimentel and Quincy Wise from CCCEH.
“Abandoning Exclusivity for Authentic Collaborations with Communities,” by Tanya Khemet Taiwo, Ph.D., from the University of California, Davis, and Janette Robinson Flint from Black Women for Wellness in Los Angeles.
“Linking Adverse Childhood Experiences and Weight Gain in Women: Insights From a Mouse Model of Postnatal Neglect,” by Analia Loria, Ph.D., from the University of Kentucky College of Medicine.
“Racial Disparities and Preterm Birth: Elucidation of the Problem and Identification of Potential Solutions,” by Tracy Manuck, M.D., from the University of North Carolina at Chapel Hill.
“Community Engagement in Women’s Environmental Public Health in Puerto Rico: PROTECT Responde,” by Carmen Milagros Velez Vega, Ph.D., from the University of Puerto Rico Medical Sciences Campus, and María Isabel Santana, PROTECT Team.
“The MIEHR Center: Unraveling Environmental Health Disparities Among Mothers and Their Children,” by Elaine Symanski, Ph.D., from Baylor College of Medicine.
“Measures of Structural Racism and Their Association With Reproductive Health Inequities,” by Maeve Wallace, Ph.D., from Tulane University.
“Social-Structural Determinants of Environmental Exposures and Uterine Fibroid Outcomes Among Systematically Marginalized Populations,” by Ami Zota, Sc.D., from George Washington University.

The workshop also featured a session titled “Identifying Gaps and Next Steps in Environmental Health Disparities and Women’s Reproductive Health Research.” Panelists included the following.

Regine Douthard, M.D., Office of Research on Women’s Health, National Institutes of Health (NIH).
Karen Parker, Ph.D., Sexual and Gender Minority Research Office, NIH.
Devon Payne-Sturges, Dr.P.H., University of Maryland School of Public Health.
Checo Rorie, Ph.D., North Carolina Agricultural and Technical State University.
ClarLynda Williams-DeVane, Ph.D., North Carolina Department of Health and Human Services, Division of Public Health.
Tracey Woodruff, Ph.D., University of California, San Francisco.
Tanya Khemet Taiwo, Ph.D., University of California, Davis, Environmental Health Sciences Center.

Also, the following NIEHS Scholars Connect Program student presenters shared their work.