The director of Rural Health Research Center and recent recipient of the Heinz Award for Public Policy, Dr. Katy Kozhimannil. (Photo by Raygen Samon)

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A public health professor whose research has led to new laws to improve maternity care in rural America has won the Heinz Award for Public Policy from the Heinz Family Foundation. 

The prize, which includes an unrestricted $250,000 cash award, has gone to Katy Kozhimannil, PhD, the director of the Rural Health Research Center and a professor of health policy and management at the University of Minnesota. “I was completely surprised,” Kozhimannil said. “Actually, I got an email that said, ‘Could you schedule a phone call with the head of the Heinz Foundation?’ ” After a brief conversation, Grant Oliphant, the president of the Heinz Family Foundation, told Kozhimannil she’d won the award. 

“I almost fell over,” she said. “I’ve nominated people in the past, but I didn’t even know I was nominated this year. It was a complete surprise.” 

Kozhimannil received the award for “driving policy change through research that examines childbirth care and maternal mortality in rural, low-income communities and among people of color; the impact of doula care on birth outcomes; and the impact of structural racism on individual and community health,” according to the foundation.

Kozhimannil’s research has focused on rural health issues, including a study of  doula care that led to changes in Minnesota law. 

The research showed that women on Medicaid in Minnesota who had doulas helping during their deliveries had a 40% lower chance of having a cesarean delivery. Kozhimannil showed that having doulas present during delivery could save most states more than $2 million per year. 

That research directly influenced the creation and passage of Minnesota’s “Doula Bill” in 2013, which is now a national model for establishing Medicaid coverage of doula care. 

“The doula research that we did is just a good clear example of doing research for the express purpose of informing policy and asking questions,” she said “We already knew that doula’s support was associated with lower rates of cesarean delivery… Doula support was associated with shorter labors, higher satisfaction, less pain. We had that evidence there… But there were still problems in accessing doula care for people.” 

The research was meant to reach the policymakers and help them make good decisions that reduced costs and improved maternal care. 

Kozhimannil’s work has also drawn attention to racial disparities in maternal care.. Most doulas are white and provide services to white, upper-middle-class women. Meanwhile, half of the people giving birth in the U.S. are not white people, Kozhimannil said.

Kozhimannil said she was drawn to health policy because of a family member who died in childbirth while working as a nurse on a rural Indian reservation. 

“I saw maternal mortality shatter my family, and to know that it is still happening today—more commonly in rural communities and up to three times more frequently among Black and Indigenous mothers—it’s just unacceptable,” said Kozhimannil. 

Kozhimannil’s research has also looked into maternal illnesses and deaths and hospital obstetric unit closures in rural areas of America. That research is bringing attention to health-care inequities in those areas. The work has found that pregnant rural residents have a higher risk of severe illness or death during childbirth than those living in cities. As more rural hospitals close their obstetric units, the health consequences for women and infants are rising. 

According to Kozhimannil, rural counties in states with weaker Medicaid programs and rural counties that are predominantly people of color have seen the biggest decline in maternity care availability.

That research helped inform the federal Improving Access to Maternity Care Act, which passed in December 2018. Some of her other work has helped her spotlight racism in the health care field. 

“Part of what we’ve talked about in this award is this idea that racism operates on multiple levels.We often think about interpersonal racism, like, there aren’t a lot of doctors out there calling their patients the n-word, right?” she said. “Most doctors don’t want to be treating patients differently. They don’t think that they are, but they are. It’s implicit bias.”

But there’s also a difference between intention and impact, she said. Even though the intentions may be good, the lack of awareness of other people’s experience may cause them to say things that have a negative effect. According to Kozhimannil, that can be especially true for white doctors, who don’t know the experience of being not-white. That’s important to look at, she said, because there are 5 million people in rural American who are not white. 

“Even though rural America is older, whiter, sicker and poorer than urban America, not everyone in rural America is old, white, sick and poor,” she said. “We have a lot of people giving birth, and many of those people are not white. Now, in rural places, it’s really important to be thinking about racial equity.”

Kozhimannil’s recent work has begun to point out the inequities revealed by racial disparities in Covid-19 deaths in rural areas. 

“Katy’s research is not only shining a powerful light on systems and practices that are contributing to inequities in healthcare, she is structuring her work in a way that enables a practical, actionable response by policymakers and those in the healthcare profession,” said Teresa Heinz, chairman of the Heinz Family Foundation. 

“Her work is demonstrating where we are falling short and showing us the path forward to ensuring that every mother receives the care and support, she needs for a safe birth and a healthy recovery.”

For Kozhimannil, the award will culminate in a ceremony later this year. She said she will use some of the award money to take her children on a post-Covid trip to Brazil. She will also create a donor-advised fund to support domestic violence services in Minneapolis-St. Paul, Minnesota. 

“I feel like with this award I am not only able to amplify rural voices with my work, but I’m also able to use the financial resources to make sure that other women have access to those (domestic violence) services and supports as well,” she said.  

The Heinz Awards were established by Teresa Heinz in 1993 in honor of her late husband, U. S. Senator John Heinz, and recognize achievements in arts and humanities, the environment, the human conditions, public policy and technology, the economy and employment, according to the foundation.