Audra Robertson Meadows, MD, MPH

Associate Professor of Obstetrics, Gynecology, and Reproductive Sciences; Vice Chair for Culture and Justice; Special Director for Equity and Systems Science, University of California, San Diego – School of Medicine, San Diego, CA; Director, Perinatal Neonatal Quality Improvement Network (PNQIN) of Massachusetts, Boston, MA


Dr. Meadows cares for women before, during and after pregnancy to ensure positive pregnancy and birth experiences.  As an Obstetrician and Gynecologist, Dr. Meadows teaches residents and medical students and devotes time to prenatal care practice innovation and advocacy.  Her clinical, public health and policy initiatives aim to prevent preterm birth and infant mortality, achieve health equity and create value.  In her previous position at BWH, she was the Director of Practice Quality and Innovation in the Ambulatory Obstetrics Practice.  In Massachusetts, Dr. Meadows holds leadership roles with the Massachusetts Perinatal Quality Collaborative (MPQC) and PNQIN (the Perinatal Neonatal Quality Improvement Network of Massachusetts).  Dr. Meadows completed the Commonwealth Fund Harvard University Fellowship in Minority Health Policy at Harvard Medical School and obtained a Master of Public Health from the Harvard School of Public Health in 2008.



Brigham and Women’s Hospital’s Center for Community Health and Health Equity Infant Mortality Disparities Initiative


Among adults living in the US (particularly those with chronic health problems), uninsured Hispanics, both immigrant and US born, are the most likely racial group to not access health care.  Portuguese speakers, regardless of birth country, are not by definition Hispanic and do not fall into any of the demographic categories currently offered by the US census department.  Thus, information regarding their current access of health care services is largely unknown.  Given the previously reported poor health care access for other financially disadvantaged immigrant groups, the purpose of my collaborative study with the Blue Cross Blue Shield Foundation was to conduct focus groups with the high concentrations of Portuguese speakers in greater Boston to investigate potential barriers to accessing health care under the new Massachusetts Health Care reform.


After obtaining IRB approval and forming a community advisory board to aid in design of the study, telephone screening interviews were conducted by the Massachusetts Alliance of Portuguese Speakers (MAPS) to recruit individuals into 5 distinct insured and uninsured Portuguese speaking focus groups.  Focus groups were held for two hours or less at various MAPS locations.  After focus groups were conducted, translation and qualitative analysis were to be completed.


Portuguese-speaking individuals who participated in the study were from 3 main countries: Brazil, Cape Verde, and Portugal.  Preliminary analysis shows that these individuals are largely satisfied with the quality of health care in Massachusetts, but dissatisfied with eligibility for and general understanding of public insurance programs.  They also reported overall dissatisfaction with access to dental care services.  Additionally, study participants largely reported being ineligible for Massachusetts public health insurance programs due to documentation issues and part-time/self employed status.  Finally, over half of the individuals reported having a regular clinic where they sought non-emergency medical care, and the majority of individuals reported utilizing emergency room services only in emergency situations.


US census department should consider including a demographic category for Portuguese speakers, particularly in states that have large Portuguese speaking populations, in order to better collect data in these communities.  Furthermore, public health insurance program information in Massachusetts needs to be distributed in Spanish and Portuguese, and more clearly delineated for these communities.  Additionally, policy considerations allowing access to public health insurance programs and dental programs in Massachusetts for immigrants (regardless of documentation status) should be considered to promote preventative care services and avoid large future costs due to advanced disease.  Finally, larger scale studies need to be conducted in Portuguese speaking communities to further understand health care access and quality concerns.                               


Valerie Bassett, Blue Cross Blue Shield Foundation