In Missouri, Black women and birthing people have a 2x higher mortality rate than their white counterparts, according to the most recent Pregnancy-Associated Mortality Review (PAMR). For pregnant people covered through Medicaid, the mortality rate increases to 7x when compared with pregnant people covered by private insurance. As an OB-GYN at Samuel U. Rodgers Health Center, Robbie Harriford, M.D., MSGH, is acutely aware of the barriers that pregnant people of color face.as an OB-GYN.
But before getting those credentials, her medical journey had its share of contours. Her dad is a retired Army lieutenant colonel, which meant she spent her formative years at Fort Leavenworth in Kansas. In fourth grade, she thought she’d become a cardiologist. Although a gifted student, her teacher told her women didn’t make for good doctors and that she should think about a different career. Dr. Harriford said that comment has stayed with her to this day.
She said the track to medical school is not only difficult for people of color but also even more difficult for women. “I didn’t really have anyone to look up to in that respect,” Dr. Harriford said. “I had family members who always supported me, and parents who pushed me, and my sister, who is a lawyer, and had similar challenges.”
Harriford went on to graduate from Leavenworth High School and attended the University of Kansas on a track scholarship. There she received an undergraduate degree in microbiology. With an interest in virology, specifically viruses like HIV, she moved to Seattle, Washington, pursued a career in research, and found it wasn’t for her. “I hated it,” she said. “I liked being around people but still wasn’t sure what I wanted to do.”
At 30 years old, she found herself back at KU in 2011. Thanks to the university’s Pre-Matriculation Program, she was able to receive support that many students of color are unable to access.
An AMSNY report found barriers for underrepresented students include:
- First-generation students are forced to navigate undergraduate degrees on their own, without guidance from parents with firsthand knowledge of how the system works.
- Improper guidance and advice from college counselors about applying to medical school.
- Working to pay tuition and/or provide support to their families, interfering with time dedicated to school and affecting grades and graduation rates. Only 11% of low-income students earn bachelor’s degrees within six years.
- High costs associated with applying to medical school, including MCAT prep courses, which are necessary for all test-takers, the high costs of applications, travel to interviews, professional attire, as well as other factors that could grow to at least $10,000.
- Black and Brown students score significantly lower on the MCAT often due to a dual focus on work and school.
To address these barriers, KU’s intensive six-week program provides entering medical students from underrepresented populations an opportunity to familiarize themselves with the first year’s curriculum. Dr. Harriford said the program was helpful and provided much-needed support.
However, what she noticed immediately during medical school was what she called a cookie-cutter approach to medicine that lacked diversity even with its practice patients. “I remember talking about that to some of my friends that the environment wasn’t diverse,” Dr. Harriford said. “I could count on maybe both hands the number of people who looked like me out of a class of 200. KU is now doing a great job of making diversity a priority in its medical school program.”
But even with that, dismissiveness from attending physicians was felt, as well as from patients who assumed she was a janitor instead of a doctor. “There were times I had to call out microaggressions from attendings,” she said. “The only way to change it is to bring light to it. And you don’t have to be offensive. But if people don’t know, how can they change? It was the same thing with patients who thought I was a janitor instead of a doctor. They felt horrible after they found out.”
While navigating the nuances of medical school, and relearning how to be a student again after an eight-year hiatus, Dr. Harriford found herself inching closer and closer to women’s health care. After doing rotations as a medical student she gravitated toward research projects that focused on women. “I was still looking at emergency medicine or cardiology,” she said, “but everything I looked at still had a connection to women. And while doing an OB-GYN rotation, it hit me, this is what I want to do.”
With her specialty in tow, the real work began – being her best as a student and as a single mom. “So I had to relearn how to study, and how to juggle parenthood for the first time,” she said. “My daughter, Emma, was five years old at the time.” With help from her parents, a nanny, and a great co-parenting relationship, Dr. Harriford’s village showed up and helped her navigate the rigors of medical school. She also learned how to navigate without having access to mentors who looked like her. Dr. Harriford attributes her background as a self-proclaimed Army brat for helping her go with the flow.
The big payoff was of course graduating, then landing at a community hospital on the south side of Chicago. There, she started off as an OB-GYN resident and then switched to family medicine. That was the first time the entire staff and attendings looked like her. “That was a really cool experience to be surrounded by and mentored in an environment like that,” Dr. Harriford said. “To this day, we still keep in touch.”
When she returned to Missouri to finish her residency, it was a complete shift. Dr. Harriford was one of three Black medical residents. But like before, she persevered. Today, as Sam Rodgers’ chief medical officer, she’s at home. Fluid in Spanish, she is able to connect with patients on a deeper level. “It’s such a blessing because the majority of my patients are Spanish-speaking,” Dr. Harriford said. “They specifically want to be seen by me because of that. It makes for such a different interaction that I describe as a holistic partnership with my patients because I not only speak their language but I understand their culture. I actively go to the places where they are from. I am able to tie their traditions to how I practice medicine. For me, that’s huge.”
“Health care is personal,” said Sam Rodgers Chief Operating Officer Janelle Harvey Jordan, SPHR. “To have someone like Dr. Robbie Harriford on the team that has an innate ability to connect to patients, meet them where they are, help them feel seen and heard, and connect with them on a deeper level that they not only return but request her specifically, is huge. We appreciate her and all of our providers. This is heart work. They display this compassion in every patient they touch.”
This heart work is evident in Dr. Harriford’s sensitivity to the disparities that pregnant people of color experience. According to the PAMR, roughly 74% of maternal deaths in Missouri are preventable. To add to that, a CDC survey correlates high incidences of pregnant people of color reporting mistreatment during prenatal visits. Specifically, 30% of Black, 29% of Hispanic, and 27% of multiracial pregnant people in the survey reported mistreatment. This included no responses to requests for help, being shouted at or scolded, not having their physical privacy protected, or being threatened that treatment would be either withheld or forced to receive unwanted treatment.
According to the AMA Journal of Ethics, racism is one of the major causes of health problems in the U.S. Between 1970 and 2004, the Black-white mortality gap resulted in more than 2.7 million Black deaths – making racism a more potent killer than prostate, breast, or colon cancer.
“Too often we hear, but we don’t listen,” Dr. Harriford said. “I think that’s a lot of what’s going on. We aren’t actually listening to the concerns of our patients. And it’s also because medicine has always been taught to be very cookie-cutter. Medical racism has been systemic since its beginnings – and it has been passed down. We are now starting to make changes, but it is happening slowly.”
Dr. Harriford said introducing students of color, early, to health care professions is crucial to increasing the pipeline of Black and Brown physicians. “Black people make up about 5% of all doctors,” she said. “It is less for Hispanic and Native Americans.” Consequently, the number of Black physicians have remained the same since 1940, according to a UCLA study.
“We also need to focus on our patients as individuals and not a disease process,” Dr. Harriford said. “Medical individuality should be something that we prioritize.”
Doulas are an important part of the paradigm, too. Dr. Harriford underscored the studies that show how doulas lead to fewer C-sections, decreased use of pain medication, and decreased incidences of depression among postpartum people. Doulas are especially important for birthing people who don’t speak English.
Sam Rodgers recognizes this and has created a doula pipeline program that centers Spanish-speaking doulas. To help bridge the gaps, one aspect of the program is to create meet and greet events between doulas and health systems so that connections are made prior to a patient being admitted for labor and delivery, a situation that is usually very high stress.
The federally qualified health center (FQHC) also actively provides a variety of training opportunities to staff that support diversity, equity, and inclusion. Roughly 60% of Sam Rodgers’ patients are not U.S.-born, with care provided in 40 different languages. For them, providing culturally concordant care is inherent. “The providers and staff look like the patients,” Dr. Harriford said. “We do a really great job of making sure our staff mirror our patients, with some staff members coming to us as former patients.” Dr. Harriford added that Sam Rodgers offers a whole-person approach to care that includes traditional health care and treatment, while also addressing social drivers of health like nutrition access and transportation, among other needs.
Sam Rodgers is also in the process of erecting a new pediatric unit to address primary care shortages and increase access to care for the community’s most vulnerable population – children. Currently under construction, the new 40-room, 30,000-square-foot pediatric wing will house WIC, behavioral health, and dental to enhance the accessibility of these services — and is slated to create 37 new jobs.
“When they are visiting the pediatric wing for WIC, our hope is that they want to return with their child,” said Sam Rodgers’ CEO, Bob Theis, CPA, BA, MA. “Everything is right there; everything is state of the art. We want to see mom back, and we want them to bring their baby, too.”
Dr. Harriford agrees and invites women and birthing people, as well as those in postpartum, to come visit – even before the pediatric wing opens. “When you walk into Sam Rodgers you will [feel] the difference,” she said. “We have staff that will go the extra mile to make you feel safe, seen, and heard. I want them to know they will get amazing care. And if for any reason we can’t provide what they need, we are going to make sure we get them someplace that can. We know that moms hold it down. If they are not happy and in a good place then the rest of the family unit can sometimes struggle. So we’ve done a good job of making sure they are well taken care of, so they can do their jobs as moms to the fullest and the rest of the family can flourish.”