Harnessing State-Level Epidemiological Data to Reduce Maternal Mortality

Education

I received my undergraduate degree in pre-med from a liberal arts college in the mid-2000s. My senior year, I was introduced to the public health concepts of prevention, population-level interventions, and empowering communities, and my interests switched to public health. I then applied to start a master’s in public health degree with a concentration in epidemiology. I really didn’t know what epidemiology was, but had been advised that the science was central to public health, a good fit with my interests and hard to learn in the field. I loved it from the start; it connected with my math and science orientation, but in a practical way. I ended up finding an amazing advisor and concentrated on maternal and child health (MCH) epidemiology.  

Eager to apply my new skills, I accepted a 2-year fellowship offer from the Council of State and Territorial Epidemiologists (CSTE). It’s a partnership with CDC that places young epidemiologists in health departments around the country. I was assigned to a state health department. I really liked the work and got to use my epidemiology skills to support planning and evaluation of real-world public health programs.

I also learned about a great CDC program that places senior MCH epi staff in long-term field assignments in states that need epi expertise. I met the team of senior MCH epidemiologists at CDC headquarters, was invited to join their meetings, and we saw each other at conferences. Joining the CDC’s Maternal and Child Health Epidemiology Program (MCHEP) team—being assigned to a state but working for CDC—became my career goal.

Because a PhD was required to become a CDC assignee, I enrolled in a PhD program in epidemiology after my fellowship.

Jobs Prior to CDC

I had teaching and research positions during my doctoral training.

First CDC Job

As I approached PhD graduation, I began the process of applying to become a CDC MCHEP assignee. Though it was a six month process to be hired, I got my dream job and was assigned to a state health department in 2014.

One of my first tasks was to help the state assess the burden of mental health and substance use disorders on women’s reproductive health. I also collected and analyzed information the state needed to revise their regulations for perinatal levels of care to conform with national guidelines (similar to levels of trauma care, perinatal levels of care are a way directing higher risk patients to a hospital equipped to care for their medical needs). I also worked over the years on maternal mortality, severe pregnancy complications, infant mortality, adolescent mental health, and many other topics related to MCH. I remained an assignee in that same state for over 9 years and my responsibilities changed and grew throughout this time.

Final CDC job

In February 2024, I became the national team lead for the Maternal and Child Health Epidemiology Program and began to supervise the team of 16 field assignees and headquarters staff. I was able to continue to work remotely from the state where I had been living rather than being required to move to Atlanta. This made sense given that I oversaw senior MCH epidemiologists stationed in state health departments all around the country. My main goals for my 1st year were to build up my management and leadership skills, and to improve communication with my direct reports who had gone through a period of management instability. I also learned more about the work done by our headquarters-based team that supported national workforce development in the MCH epidemiology field. For instance, one staff member led a partnership with a university to match graduate students with health departments for a program evaluation practicum. Our team also co-sponsored a national MCH epidemiology conference and supported training programs for MCH epidemiology fellows. I was beginning to work on developing a strategic plan for our team that would bring together the many facets of the work our team was doing to support building and expanding the field of MCH epidemiology. But unfortunately I did not get to finish building out and implementing that vision and strategy.

Proudest Achievement

I’m proudest of how I helped my state health department adapt their approach to reviewing cases of maternal mortality, which aligned with best practices, improved data availability, and influenced health policy in the state.

Impact of My Work

The greatest impact I made was during my time as a state epidemiology field assignee when I re-designed the state’s maternal mortality review process. While the state had been examining maternal deaths for years, it needed to be done more systematically and efficiently. We revamped the whole process from the ground up, beginning with expanding review committee composition to include social workers, case managers, doulas, program managers and policy people—experts who could see beyond the medical reasons for the death of a particular woman and who knew which factors we could impact. I had to figure out how to collect data on these broader issues in a succinct but meaningful way—one that would feed into the standardized system for conducting maternal death reviews that CDC was developing. From this work, I also led the development of the state’s first state maternal morbidity and mortality report. It included not only rates of this devastating outcome, but also causes and contributing factors at multiple levels (e.g., system, community, healthcare, family, individual). Finally, it made relevant, actionable, prioritized recommendations for practice, programs, and policy. When we held a press conference to release the report, the state’s 1st lady and the U.S. Surgeon General attended. Even more exciting, some of our major policy recommendations were implemented. For example, we became the 1st state in the country to universally expand Medicaid coverage from 60 days post-partum to 12 months.  

Leaving CDC

Unfortunately, after only about 13 months in this team lead role, my entire team and I received RIF notices on April 1. Although I had worked for CDC for a decade, my second-to-last position was a Title 42 (i.e., a fulltime, time-limited, renewable position with benefits). With my promotion, I was on probationary status for a year which ended in mid-February 2025. However, I received no documentation about the status change from HR, and I wrote them several times to create an email trail. I did not receive any replies or indication that my HR file had been updated.

In mid-February, my supervisor called to say she had heard that all my state assignees (all of whom were Title 42) would likely be fired. I alerted my reports to prepare for this possibility. It was a very confusing time, and it felt very ominous, but the weekend came and went with no one fired. We heard that, at the last minute, they had decided not to fire the 06-01 series health scientists in that round of lay-offs. We were on edge from then on.

In late March, there were rumblings of a wider reduction-in-force (RIF) and executive orders had come out, but we didn’t know who would be affected. Our Center leadership kept telling us that they had not been involved in the decision-making and could only wait to hear about the details on the news. On April 1, I woke up early and already had 75 missed text messages from frantic team members. My entire team had received RIF notices and was being eliminated, along with 75% of our division.

You can’t fully prepare mentally. Beyond the shock, there was fear about how long it would take me to recover financially and find a new position. I had been determined to stick out my role at CDC as long as I could, for the sake of my team and our field, but frankly, there was a bit of relief when the decision was made for me. The previous three months were so stressful—federal employees were so badly treated. We couldn’t talk to external partners, we couldn’t present at public meetings, the words we used were being scrutinized, and the 5 bullet points that we had to send in weekly had no real purpose except to make you paranoid and create a hostile environment. The edict against DEI-AB particularly troubled my group because so are so many inequities in maternal and child health outcomes—we really didn’t know what it would mean to continue MCH research without “equity.” It all added up to a complete loss of autonomy. Our scientific expertise wasn’t being honored and it was hard to know what to work on with looming threats of a RIF.

Future Plans

I’ve been able to move on and I feel healthier without the chronic stress. I will have a new position as a research faculty member at a university once my official separation from CDC occurs. I’ll lend scientific expertise to some on-going medical research projects in maternal and child health. Academic research was not a specific career goal of mine, but it’s different and a fresh start. It’s time to regroup.

If I came back to CDC, I would need to continue to work remotely, something me and my team had shown we could do well. My children are settled in school and my aging parents and in-laws are nearby.

Other Comments

To come back to CDC, there would have to be major changes guaranteeing that I would not lose my job arbitrarily and would be allowed to do my job effectively and appropriately. Scientists would need to be given autonomy to pursue their research without fear of censorship. I don’t know how that trust can be rebuilt in a future administration; it will take a lot to ensure that protections are in place that cannot be undone on someone’s political whim.