Q&A: UW-Madison director and researcher Jill Denson takes action-oriented approach to studying maternal, child health in Wisconsin

Jill Denson is the interim director of the University of Wisconsin-Madison Prevention Research Center (PRC). The PRC is one of several nationwide CDC-funded centers researching preventative care and risk reduction for chronic illness. At UW-Madison, the center studies maternal and child health issues aiming to address these topics through community and action-oriented research. 

Denson previously worked as a social worker in Milwaukee County and utilizes her experience in the field to inform her perspective as a researcher, she said. Always interested in working with children, families and mothers, Denson’s introduction to the Black reproductive justice movement informed her research on structural determinants of pregnancy intention and reproductive decision making among African American women.

This interview has been edited for clarity and brevity.

What are some of your responsibilities as interim director of the Prevention Research Center at UW-Madison?

Along with my wonderful and talented staff, we oversee and run the center. That means a lot of collaboration with academic staff across UW and community partners. We have a community advisory board and a translational partners panel. 

We also are building relationships with public health departments across Wisconsin and local community health organizations. Our goal is community-engaged research that is focused on prevention and maternal and child health throughout Wisconsin.

What is a Prevention Research Center?

We are one of 26 research centers around the United States funded by the Center for Disease Control. Each center has a core research project that they focus on. They all have several other research agendas as well, but they have one main research agenda. 

Our specific area is maternal and child health. That is because of [Wisconsin’s] disparate rates in maternal health, maternal mortality, infant mortality and child health.

Right now, we are the only center that is focused on maternal health, and our core research project is focusing on postpartum depression in the home visitation space, so preparing and supporting home visitors to be able to support birthing folks and their families if the birthing person is experiencing postpartum depression.

You were a social worker for a long time, so how did the kind of community work you did prepare you for your current role within academia?

All of my social work experience was in Milwaukee County. So early on, I had an interest in working with women, children and families. In doing that work in various roles throughout my career, I ended up working with birthing people and people parenting very young children.

I would say that prepared me for my role because it's not something that I know because I researched or read about it. I actually sat in on homes with women and really focused on social determinants of needs, particularly needs of the birthing person — be it mental health, housing insecurity or the need to put food on the table. 

I also learned that the communities that many of these women are in have lots of strengths and have really positive attributes that I think are often overlooked. I think that is why I am really interested in community-engaged research because the community has so much to offer. First of all, they know their strengths and their barriers much better than anyone else would know. We, as researchers, are often too focused on individual and community deficits, but they have a lot of strengths.

Communities make really good partners when we're talking about research that can be useful, that can be disseminated and can be translated to make a difference in that specific community. That goes further than a research article in a journal that very few people are going to be able to read.

I like community-engaged research because the whole goal is leaving something tangible for the community. They should be better off because they interacted with us in the research project.

Did your community work and prior interest in working with women, children and family change your view of reproductive justice both as you continued as a social worker and now as a researcher?

I don't know if it changed it, but it certainly informed it. I didn't learn about reproductive justice and social and structural determinants of health as a social work student. I learned on the job because I was meeting with real people, families and individuals. I was involved in a lot of community events, work groups and coalitions. 

One year that really changed my trajectory of my passion in my work was a conference that I attended. I chose a session on reproductive justice, a term that I had never heard of before. Dr. Lynn Roberts, a researcher at CUNY, presented on a research project that used a reproductive justice framework. My mind was blown. It changed my way of thinking and helped me to think more critically about my work. It was built among traditional white feminist theorist teachings on reproductive rights.

Certainly, reproductive justice believes in reproductive rights, but it goes a little further. It's like women should have the right to have children if they want, as many as they want or not have any children whatsoever.

It even goes one step further, that I think is really important for communities of color, particularly Black communities — the right to parent children in a safe and healthy environment. That means that we want our children to be able to go and play like normal and not worry about being accosted by gunfire, or we want our kids to be 16 years old and they can drive to the grocery store and not have to worry about the interaction with law enforcement. And that we have our own culture and our own values in how to raise our own children — we've been doing it forever.

We should have that autonomy and respect to be able to raise our children the way that we want to. So that reproductive framework was new, it was very informative, and I just embraced myself into it.

Thinking about more recent events, like the post-Roe world, how did this current event add extra intersections and angles to the Black reproductive justice movement?

I think bodily autonomy is one of the greatest things that we can have. It's so important, and you think about it really when it's limited or you don't have it or there's a thought that you don't have it. I think for Black women, there's been this historical aspect of not having bodily autonomy since coming to this country. I think that affects Black women both mentally, emotionally and physically. 

We know from other states who have had more restrictive abortion laws that the maternal mortality rates have been impacted, and women's health has been impacted by that. We already have this really disparate maternal mortality and morbidity rates, so not having access to health care — the full spectrum of health care — we can expect that this gap will probably even become greater.

How about the COVID pandemic, just because I know that's put a huge strain on the healthcare system as a whole?

Yes, it put a huge strain on the healthcare system. Just recently, the CDC put out rates on how maternal mortality really spiked during the period immediately after COVID, again especially for Black and Indigenous communities. Those communities were affected overall more by COVID, but it also directly impacted maternal mortality as well.

I also saw in your bio that you're a member of the Wisconsin Maternal Mortality Review group through the Department of Health Services. What is this group responsible for, and how does it function addressing maternal mortality in the state of Wisconsin?

The review is made up of an interdisciplinary group of professionals who review maternal deaths. 

When people die within 364 days of giving birth, we receive those cases and we decide if it’s because of a pregnancy-related issue or not. There's medical and social factors. We review those cases and the statistics, and then we give recommendations to the CDC.  There are maternal mortality reviews across the country, but of course, we focus only on people who have died in Wisconsin.

I was wondering if you could talk a little bit about your PhD dissertation from the UW-Milwaukee School of Public Health and why you chose that topic, and any potential impacts the research you did throughout that project has led to?

I had been working with birthing people and providing home visits, and meeting with patients during clinic visits and hospital stays. I would come across birthing people who were either unsure about their pregnancy or a bit ambivalent about it.

At the time, you didn't really have to be pregnant if you didn't want to — there was a plethora of contraceptive options. Black women in particular were less likely to use contraceptives or contraceptives that are more reliable. I had encountered so many Black women who shared that medical providers were adamant about the various choices of birth control available to them. 

I often wondered what goes into the decision-making of whether I want to have a child or not. Is it a partner, is it societal views or is it the doctor being coercive with birth control?

That is why I did my dissertation topic on that because I knew it was going to be very nuanced. I knew it wasn't going to be just because birth control is too expensive. I didn't want to do a comparison between Black women and white women. I was really interested in Black women's experiences. So the comparison was by income level among the women in my study.

When I went to school for my PhD, I knew that I wanted to be an action-oriented researcher, and I didn't want to do my work outside of the community. I strongly believe in participatory research, and so that is why I chose the group concept mapping because the participants are involved in every level of it, so research participants get to help interpret the data which I think was a strength of the study.

Are there any questions you wish I would have asked about your research or topics you wish we discussed before we finish up?

Sometimes we hear the term “All Lives Matter” when we focus on Black maternal mortality or Indigenous maternal mortality. When HIV became prevalent, we made the mistake of saying, “Oh, it doesn't impact me because those are gay white men there, so it's not going to impact me.” Soon after, HIV was prevalent across society.

If we would have been all hands on deck, then I don't think we would have seen the spread of HIV the way we did. We used to think of heart disease as a male issue, but now, the number one killer of women is heart disease. 

If we had paid attention to that early on, then maybe it wouldn't be the number one cause of death among women. 

What I say about maternal mortality and infant mortality — if we want to contain it, reduce it and eliminate it — we will have to pay attention to who is most affected by it now in order for it to avoid increasingly impacting a larger population.

We have to be all hands on deck now, we have to put our resources and our research in that now. Otherwise, in maybe five years or 10 years, then it'll be spreading to more and more communities.

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