In our Five-Question Feature to mark the 10-year anniversary of Ariadne Labs, we highlight the staff and faculty behind the lab’s compelling work.
Katherine Semrau, PhD, MPH, director of the BetterBirth Program at Ariadne Labs, has more than 20 years of experience in the fields of maternal, newborn, and child health and epidemiology, including significant key years in Zambia. She has a PhD in epidemiology from Boston University and an MPH in international health and epidemiology from the University of Alabama-Birmingham.
From 2001-2004 she worked on a randomized control trial in Zambia that examined the impact of breastfeeding on long term health outcomes. As a team member of the Zambia Exclusive Breastfeeding Study, she ran the study laboratory and eventually coordinated enrollment, data collection and data management activities. She then returned to the U.S. and collaborated on multiple projects in Zambia, Namibia, South Africa, India and the Republic of Georgia.
“That study really opened my eyes to the importance of data and research and finding the right interventions that work – not just at an individual level, but at the systems level,” she recalled. “That’s what I think led me eventually to go beyond the moment of the research trial to study the bigger picture.
Her research has focused on prevention of maternal and child mortality, improvement of quality of care, and prevention of mother-to-child transmission of HIV. After joining Ariadne Labs in 2014, she led one of the world’s largest maternal/newborn health studies: the 2011-2017 BetterBirth trial in India. More recently, BetterBirth has expanded its work into new areas, including improving the health of low birthweight infants through the LIFE study, which documents current feeding practices, growth patterns, and other health outcomes.
Q: Do you have a story that illustrates the impact of Ariadne’s BetterBirth work?
A: Two stories. We were working on the BetterBirth trial in India to see if the implementation of the WHO Safe Childbirth Checklist along with peer-coaching impacted providers – if they gained better skill sets to be able to provide high quality care. One of the most impactful moments for me was – even though it wasn’t part of the checklist but part of the spirit of improving quality of care – when privacy screens were put up in a labor and delivery suite so that women were able to give birth in privacy and have some dignity and autonomy and respect. Women deeply appreciated that ability to have a separate space, to have this moment of birth be between them and their provider. So that change in privacy screens was very remarkable to me.
The second story involves the small and vulnerable newborn work that we’ve been doing over the past three years through the LIFE study. These are very tiny children, under five pounds, often born before 37 weeks of gestation. When I was visiting the facilities, I saw a woman holding her newborn in a kangaroo mother care fashion, which is where the mother holds the child skin to skin, keeping them warm and helping them regulate their body temperature. I knew that provision of kangaroo mother care, particularly for this group of women and families, could make a huge difference. It improves bonding, it helps the baby’s health, it helps the mom’s health. This underscores the need for a health system that supports that connection between moms and newborns.
Q: Where do you think the BetterBirth Program is going in the next ten years?
A: So we certainly haven’t solved maternal and newborn mortality issues, not yet. I think the work going forward will be even deeper and more detailed, particularly in subpopulations that are really struggling with high rates of mortality, whether that be children born with low birthweight or born premature, or women who are giving birth in environments that have very poor quality of care. I think there will be more focus on health equity, and we will use a health equity lens, to see who are the populations that are being served and who are not.
We have a body of work focused on what we’re calling childbirth induced vulnerability. So the idea is that when a traumatic event happens around the time of birth, what are the long term consequences of that? Not just in physical health, but mental health, emotional health, and financial health. There are so many threads that we think are related back to that event that set people up in terms of their health trajectory and then how they engage with the health system or whether they avoid the health system because they had a poor experience.
Q: What else do you see in the future?
A: I think we have to discuss climate change. I mean, we know that pregnant people have poorer health outcomes as it gets hotter. Children have higher rates of mortality where it is hotter. It is not an area that Ariadne has advanced into at this point. But I think just like the health equity lens, and how we think about asking questions in our content areas, I think climate will become more and more of an influencer.
Q: Do you think the COVID-19 pandemic impacted the labs’ work?
A: Yes. We were nimble enough to turn our focus to COVID-19, and I think we also delivered some really useful tools for people to engage with. Asaf’s commentary, “This is Not a Snow Day” helped ground people — it captured what they were feeling, what they were thinking, and how unsettling it all was. I think Ariadne did a really good job of trying to focus on messaging, focusing on [keeping schools safe], and focusing on the vaccine scale up. We became a trusted resource.
Q: Ariadne Labs operates in a wide variety of areas. Is that energizing for you?
A: I like working on a lot of different things at the same time. Within the BetterBirth program, we started off with one huge, enormous study, and then we expanded out. At one point we had like 11 projects going at one time. What I like about Ariadne is I think there is a drive and vision to advance the work. People really push the idea that you can make health care better and you can make a difference.