Background

Over the past 20 years, the Department of Epidemiology has established itself as a leader in scholarship and education pertaining to gynecologic, reproductive, perinatal, and pediatric health. The goals of the proposed initiative are to 1) enhance schol­arly and translational activities relevant to gynecologic, reproductive, and perinatal health and 2) increase the visibility of our existing efforts in this area on Boston University Medical Campus [Boston University Schools of Public Health (BUSPH) and Medicine (BUSM)], across Boston University (BU), and outside of BU. Through this initiative, we will:

  1. Foster an engaged and inter-disciplinary community comprising faculty, staff, and students across multiple departments at BUSPH (epidemiology; community health sciences; health policy, law and management; and environmental health) and BUSM (obstetrics and gynecology; maternal-fetal-medicine; pediatrics; and psychiatry);
  2. Organize a seminar series to recognize and support outstanding science occurring at BU, both for internal and external audiences;
  3. Increase the visibility and impact of our work, by launching a website and social media presence to promote the excellent scholarship in this space at BU;
  4. Create new and nurture existing collaborations among initiative members;
  5. Strengthen initiatives to secure external funding related to these themes by providing an infrastructure of administrative and scientific support.

According to Sister Song (https://www.sistersong.net/reproductive-justice/), a leading community-based organization dedicated to reproductive justice, the term “reproductive justice” was coined by a group of Black women gathered in Chicago in 1994, just before the International Conference on Population and Development in Cairo, where world nations agreed that the right to plan one’s family was central to global development. This group of Black women recognized that the women’s rights movement, led by and representing higher-SES White women, could not defend the needs of women of color, other marginalized women, and transgender people. There was a recognition that marginalized communities needed to lead their own national movement to uplift their needs. Rooted in the internationally-accepted human rights framework of the United Nations, the reproductive justice framework combines reproductive rights and social justice. Reproductive justice pioneers launched their movement by publishing a full-page statement with 800+ signatures in The Washington Post and Roll Call. In 1997, SisterSong was formed to create a national reproductive justice movement. At BUSPH, we are deliberate in centering this initiative within a reproductive justice framework.* This framework asserts that every individual has the right to: a) decide if and when they will build their families and the conditions under which they will give birth, adopt, or parent; b) decide if they will not get pregnant and their options for preventing or ending a pregnancy; c) parent the children they al­ready have with the necessary social, emotional, and financial supports in safe environments and healthy communities, and without fear of violence from individuals or the government; d) bodily autonomy free from all forms of reproductive oppression; e) express their sexuality and spirituality without violence or shame; and f) quality of life before and beyond the ability to give birth or parent.

The Need for an Initiative on Gynecologic, Reproductive, Pregnancy, and Pediatric Health

At this moment in United States (U.S.) history, there has never been a more important time for an initiative to promote the gynecologic, reproductive, and perinatal health of the population. More than two years after the U.S. Supreme Court overturned the constitutional right to induced abortion, 21 states have banned or severely restricted access to the procedure. Women and pregnant individuals, and their health care providers, have shared their personal stories about the impact of criminalizing aspects of reproductive care on their mental and physical health. PROGRESS initiative members have evaluated the post-Dobbs landscape for research (Willis et al., PPE 2024) and clinical practice (Ahmed A, et al. J Law Med Ethics. 2023), increasing uncertainty about future access to contraception, abortion pills, and fertility treatment.

Alongside these threats to abortion and contraceptive access are growing concerns about declining birth rates in the U.S. The most recent year for which there are national data (2023), the birth rate was the lowest it had ever been in recorded history. The extent to which the declining birth rates are attributable to the economy, cultural factors (e.g., higher percentages of women in the workforce), or environmental factors (e.g., chemicals in the environment, nutrition, anthropometrics) is unclear. Moreover, there are documented racial and socioeconomic inequities in fertility treatment access and fertility success rates that are not wholly explained by state insurance mandates (Korkidakis et al., 2024). Research was limited and conflicting on the extent to which various measures of infertility (trying to conceive for ≥12 months without success) vary by race and ethnicity. In the largest prospective preconception cohort study worldwide (>22,000 participants), Pregnancy Study Online (PRESTO), which is conducted here at BUSPH, investigators observed large differences in fecundability (pre-cycle probability of pregnancy) across racial and ethnic groups. Compared with non-Hispanic White participants, fecundability was 23-40% lower among non-Hispanic Black, non-Hispanic American Indian/Alaskan Native/Indigenous, and Hispanic other/unknown race participants (Wise et al., Hum Reprod 2025). The 12-month cumulative incidence of infertility showed similar differences across race and ethnicity.

Finally, there has been a crisis of pregnancy-related (“maternal”) morbidity and mortality in our country. For instance, the U.S. maternal mortality rate of 22.3 per 100,000 was more than 50% higher than the rate in the next-highest nation studied. Racial inequalities in maternal morbidity are extreme. The maternal mortality rate of Black women in the U.S. was more than double the nation’s overall rate in 2022. Differential access to quality health care, structural racism (i.e., in our communities, neighbor­hoods, and the health care system), lack of midwifery or doula care, and inadequate supports for parents, such as paid leave, are considered important contributors to the gap between the U.S. and other nations. PROGRESS initiative members have published research on factors that drive these health disparities (Declercq E, Thoma M. JAMA. 2023; MacDorman MF, et al. PLoS One. 2021) and Dr. Parker has been pioneering cutting-edge research at Boston Medical Center (BMC)—one of the nation’s largest safety-net hospitals—on postpartum hypertension, an under­studied but important cause of pregnancy-related morbidity and mortality (Mujic E, Parker SE, et al. J Am Heart Assoc. 2024).

Our ultimate goal is to create a distinct and uniting theme that sets the PROGRESS initiative apart from other initiatives in the school and university at large. We strive to elevate a set of research topics that profoundly shape population health and yet have been severely under-researched and under-funded by the NIH. These topics include issues that are distinctly gendered or stigmatized (e.g., menstrual disturbances, gynecologic conditions, ovarian disorders, sexual dysfunction, induced abortion, spontaneous abortion, transgender health, disability rights), differentially affect Black women and other marginalized groups (e.g., gestational diabetes, hypertensive disorders of pregnancy, preterm birth, and stillbirth), and/or are outside of the mainstream of clinical research or particularly methodologically challenging (e.g., environmental determinants).

Other examples of areas in which our departmental members have key expertise:

Racial and ethnic disparities in pregnancy-related morbidity and mortality, with a focus on preterm birth and stillbirth. A range of researchers at BU study this topic. At the forefront, Dr. Collette Ncube is a social and perinatal epidemiologist with re­search interests in understanding and addressing the social and structural drivers of racial and ethnic disparities in pregnancy-related and infant health. Specifically, her work investigates the role of neighborhoods and the larger social context in producing and perpetuating these disparities over the life course and from one generation to the next. She uses novel methodologies in the operationalization and examination of structural racism. Key publications include those on structural drivers of antepartum and intrapartum stillbirth (Ncube CN, et al. BMC Pregnancy Childbirth. 2022), low birth weight (Ncube CN, et al. Ethn Health. 2019), and preterm birth (Ncube CN, et al. J Womens Health (Larchmt). 2017).

Environmental drivers of reproductive and perinatal outcomes. Several members of this initiative have investigated a wide array of environmental exposures. For instance, Dr. Mary Willis, Assistant Professor, is a spatial epidemiologist who investigates the health impacts of energy and environmental exposures. Much of her reproductive and perinatal work is supported by an NIH Director’s Early Independence Award, the first one at BU. Recent publications led by Dr. Willis include topics such as traffic-related air pollution regulations and perinatal health outcomes (Willis et al. 2024, Environ Int, Willis et al. 2023, JAMA Net. Open), oil and gas development exposures in the preconception and perinatal period (preconception mental health: Willis et al. 2024, Am. J. Public Health, hypertensive disorders of pregnancy: Willis et al. 2022, Int. J. Epidemiol), and built environment determinants of fertility (green space: Willis et al. 2023, Environ. Health Perspect, neighborhood deprivation: Willis et al. 2022, JAMA Net Open, residential segregation: Lovett et al. under review at J Urban Health). Additional research, led by Dr. Amelia Wesselink in collaboration with members of the Environmental Health Department, including Drs. Kipruto Kirwa and Jonathan Levy, has been conducted on air pollution and reproductive outcomes. Dr. Birgit Claus Henn, Associate Professor of Environmental Health, is leading additional research on exposure to environmental chemicals and pediatric neurodevelopmental outcomes, using the latest statistical methods for analyzing chemical mixtures (Claus Henn B, et al. Curr Opin Pediatr. 2014). Her expertise in the analysis of chemical mixtures has also been instrumental in evaluating exposure to endocrine-disrupting chemicals and uterine leiomyomata in the SELF cohort (https://detroitself.org/).

Gynecologic health, including menstrual health. This understudied area of investigation is an area of intense research activity in the Department of Epidemiology. For example, reasons for the Black-White disparity in incidence of uterine leiomyomata, a condition that remains the primary indication for hysterectomy, and causes severe reproductive morbidity (e.g., menorrhagia and anemia) are still unclear. Drs. Lauren Wise and Amelia Wesselink have published extensively on environ­mental determinants of this debilitating under-researched condition (Wise LA, et al. J Expo Sci Environ Epidemiol. 2024; Geller R, et al. Environ Health Perspect. 2025; Wesselink AK, et al.  Am J Obstet Gynecol 2023). Likewise, menstrual disturb­ances (including abnormal uterine bleeding and dysmenorrhea) had received little attention from the NIH until anecdotal reports emerged on social media about the potential effects of COVID-19 vaccination. BUSPH researchers have been at the forefront of research in this, obtaining 1 of only 5 NIH special grants issued for the immediate study of this research question, culminating in several publications on this topic (Wesselink et al., 2023) and other reproductive outcomes, including fertility (Wesselink et al. 2022), miscarriage (Yland et al., 2023), and a review article on men­struation and other women’s health outcomes (Payne et al., 2024). Emerging research by Dr. Amelia Wesselink from PRESTO documents important racial and ethnic disparities in menstrual disturb­ances (Wesselink et al., SER conference abstract, 2024). In addition, a recent graduate from our PhD program in epidemiology, Dr. Ruth Geller, has highlighted novel drivers of dysmenorrhea and abnormal uterine bleeding, including neighborhood factors and hair relaxer use.

Sexual health, including female sexual function. Compared with male sexual health and erectile dysfunction, female sexual dysfunction has received comparatively little attention from major funding bodies and pharmaceutical companies. Rigorous scientific investigation of female sexual dysfunction is necessary to understand its causes and, ultimately, inform treatment development. The magnitude of vulvodynia, a debilitating and stigmatizing condition that affects millions of women, has been studied by Dr. Bernard Harlow for 25 years. He was the first to show that nearly 8% of females by the age of 40 will develop vulvodynia. His more than 35 scientific publications in this area have helped solidify the foundation that vulvodynia is a consequence of immune dysfunction that’s impacted by a wide variety of biopsychosocial risk factors.  

A recent interdisciplinary collaboration led by Drs. Julia Bond at BUSPH and Kate White at BMC yielded novel insights about the prevalence of preconception female sexual dysfunction (Bond et al., Am J Obstet Gynecol 2023) and its relationship to time to pregnancy (Bond et al., Am J Obstet Gynecol, 2024). Data generated by this collaboration have also sparked novel lines of inquiry into environmental determinants of female sexual dysfunction (Schildroth et al., Environ Health Perspect 2025). Dr. Kimberly Nelson, Associate Professor in the Department of Community Health Sciences, is an expert in adolescent sexual health research and is currently working on a project to characterize sexual practices in a large survey of adolescents and evaluate how COVID-19 affected adolescent sexual health.