Behind the Science: Investigating maternal nutrition and preeclampsia in low income settings

Interviewee: Maggie Woo Kinshella, PhD candidate, University of British Columbia. Authors/Editors: Romina Garcia de leon, Shayda Swann (Blog Co-coordinator).

Published:

Could you briefly explain what your research is?

My PhD research is looking at the relationship between the food that women eat during pregnancy and our risk of developing preeclampsia, which is a serious condition during pregnancy characterized by high blood pressure in the second half of gestation alongside signs of maternal organ damage, especially in the liver and kidneys. My research is particularly looking at this relationship in Sub-Saharan Africa, where there’s a disproportionate burden of maternal deaths, as well as higher prevalence of malnutrition.

This work is within the PRECISE Network, which is a large prospective pregnancy cohort in three countries in Sub Saharan Africa, Kenya, The Gambia and Mozambique, to give us an idea of what’s happening in East Africa, West Africa, and South Africa. The overall goal is to do research on placental conditions — including preeclampsia — in Sub-Saharan Africa, as most of the research has been done in high income settings like Canada, the United States, or the UK, where pathways of risk may be different. It’s really trying to look at within these resource limited settings, whether there are different pathways, such as a higher prevalence of malnutrition.

The research uses mixed methods, which I’m super excited about. There’s a quantitative component using the PRECISE Network surveys where they asked women about their medical history and socio-demographics, as well as did a dietary diversity score, which is the number of food groups that the woman eat in the past 24 hours. I’m going to be looking at whether a woman’s dietary diversity is linked to developing pregnancy hypertension.

I also did qualitative community-based research in each of the three countries, it was really neat! I was able to go to the three countries and it was so wonderful to be able to work with the local staff. For over a month in each country, I did focused ethnography, where we did participant observation and shadowed pregnant women and recently-delivered mothers throughout the whole day to understand where they’re getting their food, how they’re cooking it. and how they’re eating it. We also did interviews with women, as well as their male relatives, other female relatives, and community leaders.

Then we did photovoice, which is a really interesting participatory research activity that involves giving cameras to women, and they took pictures of how they made the food, where they got the food from, as well as barriers and facilitators. We then printed out the photos and we had a discussion about them afterwards.

What led you to become interested in this women’s health issue with the maternal diet and hypertension?

I’m taking a human rights approach to health in my PhD. Really early on, looking at this research, I realized there was a there was a there was a systemic neglect of women’s health within maternal diet research.

The Safe Motherhood Initiative is really momentous in getting people to think more about maternal mortality, because they realized that there was this “measurement trap”. Maternal and child interventions ended up having a bigger benefit on child health and assuming that that would spill over into women’s health. However, that wasn’t reducing maternal mortality rates, because that reducing maternal mortality rates requires explicit interventions on facility maternity care, for example. They call this a “measurement trap” because these indicators of women’s health are systematically neglected. Similarly, nutrition programs are often intervening with pregnant women, and within mothers with small children, but they’re measuring the outcome in child growth. So, you’re intervening with the women, but you’re not measuring the outcomes in women. I think that is a very systematic neglect and an injustice.

For example, there’s a lot of research out there are multiple micronutrients, so multivitamins, and they never measure preeclampsia as an outcome. They hardly even measure maternal mortality. It’s always low birth weights and other outcomes like that, which I think is a huge missed opportunity to look at some of these maternal indicators.

Why do you think it’s important to study women’s health?

Women are are often seen in the lens of reproduction, which can be a big part of identity and things like that. However, it’s looking at women as instrumental that exploits gender norms and stereotypes, rather than being empowering. I think you cannot have community empowerment if women are systematically neglected and you can’t have women’s empowerment without our health and you can have health without food. I think looking at food is really fundamental.

It seems you have been involved in a lot of community work, can you tell us a bit more about what you’ve accomplished outside of academia?

I think it’s really important to ground our academic work in terms of how it’s applied or to have an idea of how things actually are on the ground. I’ve been involved in a small NGO in Western Africa that worked with household health and gender equality projects. We had a program to raise awareness and have a community resource center to prevent sex- and gender-based violence in a small community in Western Kenya. We also had a women’s health education program. With this program, we did some fundraisers that included kayaking from Vancouver up to Alaska to raise money and awareness, as well as we cycled from Vancouver all the way down to Argentina, which was really amazing.

I’ve also spent some time in Ethiopia. I was a volunteer there as a technical adviser on reproductive, maternal and child health communications and health promotion for the Benishangul Gumuz regional Health Bureau. I was working on was helping them reinvigorate their health promotion and health education program, particularly around understanding perspectives of the major Indigenous groups in the area.

I’ve also done some work in the Downtown Eastside, as a frontline mental health worker in various housing, treatment, and detox facilities, as well as doing community-based research there. I was a freelance research consultant, working with different organizations on issues that came up during clinical work that they wanted some more clarification and understanding about.

What impact do you hope to see with your work years from now?

I’m hoping to be a part of this paradigm shift to value and measure women’s health indicators.I think this neglect is systemic. As people kind of realize that, “Oh, wow. We didn’t measure this before”, hopefully that builds momentum with more groups measuring it, focusing on it more, and realizing different areas where there might be a systemic neglect.

Overall, I really hope that this research, depending on the findings, is able to speak to the relationships between maternal diet and maternal health and hopefully support meaningful and appropriate prevention and interventions.

Where can people find out more about your work and what you do?

You can find me on Twitter @MaggieWooK or on our website. You can also email me at maggie.kinshella@cw.bc.ca