Subasri Narasimhan, PhD, MPH – Postdoctoral Research Fellow and now Research Assistant Professor, Emory University’s Rollins School of Public Health and the Center for Reproductive Health Research in the Southeast (RISE)
About Subasri Narasimhan
Subasri Narasimhan was a Postdoctoral Research Fellow at the Center for Reproductive Health Research in the Southeast (RISE), at Emory University’s Rollins School of Public Health. She has transitioned to a faculty appointment as a Research Assistant Professor at the Hubert Department of Global Health, also at Emory University. Dr. Narasimhan’s scholarship uses mixed methodologies to study the public health impacts of policies that restrict women’s access to abortion, contraception, and other reproductive health services. She earned her PhD in Community Health Sciences at the Fielding School of Public Health at the University of California, Los Angeles (UCLA), where her work focused on reproductive health among marginalized populations in Sub-Saharan and East Africa and Southeast Asia, and her Master of Public Health (MPH) with a specialization in Maternal and Child Health at the University of North Carolina at Chapel Hill (UNC-Chapel Hill). Dr. Narasimhan also attended UNC-Chapel Hill as an undergraduate, where she completed her Bachelor of Arts (BA) in Anthropology and Environmental Studies.
[OnlineEducation.com] You are a postdoctoral research fellow at Emory University’s Rollins School of Public Health and the Center for Reproductive Health Research and are transitioning to a faculty position there, correct?
[Dr. Narasimhan] Yes. It’s the Center for Reproductive Health Research in the Southeast, which goes by the acronym RISE, and I am a postdoctoral research fellow. A fellowship is looked at as a training program. If you think of clinical medicine, fellowships are a way to get training in a particular niche or area of medical practice. It’s similar for a postdoctoral fellowship in a field like public health. A postdoctoral fellowship is a step up the ladder for people who have completed their doctoral degree and who are interested in becoming an academic and working at an academic institution. Not all postdoctoral fellows become professors or enter purely academic fields after their fellowship, but it is a way to develop the skills needed to become an independent investigator, which is really the goal of the fellowship.
I spend most of my time working on various research projects, collaborating with colleagues, and thinking up new research projects. And a large proportion of the work is trying to find funding for particular research projects.
[OnlineEducation.com] I think over the past year, many of us have learned that public health is a thing and that it is a broad field that includes, as we’ve seen, responding to a pandemic, but that also encompasses preventative medicine, epidemiological research, program administration, and health communication. How would you situate your work in the larger realm of public health?
[Dr. Narasimhan] I am a public health social scientist. That means that I am trained in area of the field called health behavior or health behavior and health education. I got my PhD in Community Health Sciences. What that means is that I try to identify the social or behavioral factors that lead to a person having negative outcomes and I look at how we can get people to take preventative measures to avoid those negative outcomes. People are complicated. We can have the greatest health program in the world, but if we don’t understand how people work and how people think and what their attitudes are, then we aren’t going to have much success implementing that program.
The thing about public health is that if it’s working well then people don’t really notice it. This year we have noticed it because so many of our public health systems and public health efforts were not working as well as we would have liked.
My specific focus is reproductive health. I look at things like contraception and reproductive health access, which are two areas of public health that tend to be highly publicized and highly controversial. I view my work through a reproductive justice lens. I don’t think of myself as a reproductive justice advocate in the sense that I am not out there working in communities at the ground level promoting reproductive justice. Instead, I am doing research in areas that are central to reproductive justice, like increasing access to healthcare. My goal is to better understand and ultimately combat some of the more coercive policies and attitudes related to reproductive health historically, particularly with minorities and marginalized populations.
[OnlineEducation.com] So, you’re looking at the impact of policy and legislation on people from a health standpoint?
[Dr. Narasimhan] Yes, and also trying to bring in the voices of people who may actually be affected by these laws and may have less privilege, which may lead to their lives being much more upended by reproductive health restrictions, abortion restrictions, contraception restrictions, and things like that. The RISE Center itself focuses not just on how laws and policies impact individuals, but also on how these policies have differential impacts on marginalized communities in the Southeast. When laws change, they are not equally applied, and they have different impact on different populations.
[OnlineEducation.com] Let’s go back to how you got into this field. You majored in anthropology and environmental studies at UNC-Chapel Hill and then you went into an MPH program at UNC-Chapel Hill, correct?
[Dr. Narasimhan] Yes.
[OnlineEducation.com] At what point or points did you decide to pursue a career in public health and what drew you in that direction?
[Dr. Narasimhan] When I was in college, I was heavily pushed toward the sciences. I took a lot of biology and chemistry courses. But I was far more interested in how people work and in trying to understand why people do the things that they do. Science classes were something that I took but that I wasn’t necessarily passionate about. I really liked the idea of working in health or medicine, and I was trying to figure out how to do that.
I ended up doing a couple of important internships that influenced my decision. When I was a junior in college, I interned under a child development specialist who taught me about qualitative research and interviewing people for research purposes. I worked on a Fragile X syndrome project as part of that internship. That was the first time I had any contact with the concept of public health and the idea that you could talk to people – in this case with parents – in order to develop a better understanding of what support and coping skills they might need when they have a child who is newly diagnosed with a disability.
At that time, I don’t think I really understood what public health was, even though I went to a university that has a very good graduate public health school. But I think that was still early on in terms of when people were starting to think of public health as a career apart from medicine.
I ended up graduating and, because I was an anthropology/social science major, I found a job as quickly as I could, pretty close by, in a hospital. I worked as a clinical researcher. In that job I had a great mentor who sat me down and said, “I’ve looked at your resumé, you’ve been working here for a long time, and you may not realize that all of the things that you’ve worked on have been related to children, women, and families. And there is an entire graduate program where you can study that. Did you know that?”
I did not know that. When I started to learn about public health, I had assumed that the only avenues were biostatistics and epidemiology, which are incredible fields and obviously very important. But in terms of the substantive work that you’re doing in those fields, that’s not really where my interest was. This mentor set me up with a few of her colleagues at UNC-Chapel Hill in the Maternal and Child Health program there and that really set me on the course to what I am doing now as a career.
[OnlineEducation.com] It sounds like you were thinking of pre-med as undergraduate, then you gravitated more toward the behavioral sciences, and then it came together when, after your bachelor’s program, you realized that you could combine your affinity for science and healthcare with your interest in people and families in public health. Is that a fair way to put it?
[Dr. Narasimhan] Essentially. I really enjoyed the scientific inquiry part of searching for answers, and I also enjoyed the writing, which are both things that you do on a day-to-day basis in the work I do now.
[OnlineEducation.com] It’s interesting that even at a large school like UNC-Chapel Hill, where they have a school of public health, you weren’t necessarily aware that public health would be an option for you.
[Dr. Narasimhan] I think now that I am a member of associations where I have the opportunity to speak with a lot of younger students about public health and careers in public health, I’m realizing that there are many more public health programs then when I was graduating from my bachelor’s program in 2006. So it is more and more common to find schools that have a major in public health at the undergraduate level. In and of itself, that can draw a lot of people into the field.
I also think that having a school of public health with a clear identity helps. There are a lot of opportunities in the field and there are a lot of ways that public health schools can help educate students about the work that happens in the field and where they might fit in to this very broad space. I think public health can tend to attract students who may have broad interests and who aren’t quite sure what they want to do. And that is one of the advantages of public health; you can work in a lot of different areas and you don’t necessarily need to specialize right away. Many of the skills you learn as you’re moving forward in public health are transferrable to various areas within the field.
[OnlineEducation.com] You went out to California to get you doctorate at UCLA and your research was on reproductive health in Africa and Asia, and now you’re doing a similar kind of work and research, but in the US. Is that accurate?
[Dr. Narasimhan] I am still finishing up some work in the Philippines and I am writing grants to look into other things in other countries, but I made a purposeful decision to come to Emory and to work here because I am from the South – I’m originally from North Carolina. So part of it was logistical, just coming closer to home. But the other part of it was that I realized that there is a great amount of human capital in the South. Unless you’re from the South you might not realize that there are so many people here who are working to improve the health of communities at the grassroots level.
I came to Emory as they started RISE because I wanted to learn more about reproductive health and reproductive justice in the South. I also wanted to be able to work on some domestic projects that would potentially have an impact on what is going on politically and legally here. That felt really important to me. So coming here was a way for me to accomplish a couple of different things and broaden my substantive knowledge.
[OnlineEducation.com] There seems to be a pretty good consensus that women are well represented broadly in the field of public health, but not in leadership and administrative positions. Does that align with what you have seen in the field?
[Dr. Narasimhan] Yes. I think that the number of women who are able to rise through the ranks to higher levels of power and into decision-making positions in public health varies by specialization. There are a lot of initiatives that have increased the number of women in the pipeline who are moving into academia and into public health, but those initiative aren’t necessarily designed to help women find a pathway to move forward in their careers once they’ve gotten there. Looking at the most recent coronavirus statistics about employment and people working from home, we’re seeing a lot of drop off among women, often because they have to take on extra childcare or eldercare responsibilities. As a result, they’ve become less “productive” in that sense that they aren’t publishing as much.
I don’t think it is controversial to say that women generally, in many fields. suffer from doing a lot of the “housekeeping” type of work. This is pretty well documented in academia and it can undercut the way women are seen within a field and the limit opportunities they are given for advancement. Within departmental hierarchies in academia, women often do serve on committees and so they are represented in that way. But, while there may be on the surface relatively good representation of women in the field of public health, we really don’t see women of color well represented, particularly in decision-making positions. That is something that needs to be highlighted, examined, and addressed.
[OnlineEducation.com] In academia, advancement is often based on seniority, so it might make sense that, in a field in which women were underrepresented twenty or thirty years ago, the people occupying the most senior positions today would more likely be men. In public health it would seem that, as you’ve already mentioned, there is variation by specialization. What have you noticed in that regard?
[Dr. Narasimhan] My experience has been that there are a lot of cis-gender women working in the field of reproductive health and they are well represented in the field. But there is still need for non-binary individuals and there has been a push to reconsider the role that men can play within the realm of reproductive health. What we may need to think about is, what does it mean if we change the dynamics of our research and does that change the dynamics of who is represented in the field?
We also don’t always take into account how much support it takes to move forward. That may also be true for women of color or non-binary people who are interested in going into a specialization like reproductive health. You need a good mentor who believes in your work.
Reproductive health research and the field itself grew out of demography fertility research and obstetric medicine, which was historically dominated by white men. That’s changed only recently but the leadership dynamics haven’t. I just think that when you dig deeper beneath what you see on the surface you find more nuance. So, just because a field is dominated in numbers by women right now doesn’t mean that it’s an equitable power structure for women, if that makes sense.
[OnlineEducation.com] It does make sense. Did you, as you were entering the field of public health, begin to notice unique challengers or hurtles for women?
[Dr. Narasimhan] I don’t think any of that was made overt to me, but I learned them over time. I was fortunate to have a number of strong female mentors, who were also women of color, who were able to show me and talk to me about how to balance the work that you want to do with other things in your life.
I know being a woman of color is an issue and that there hasn’t always been space for or recognition of women of color. What has been great about the last decade is that I have seen a change in that regard at national conferences and within professional groups. There seems to have been a genuine effort to have women of color at the helm and to have more women of color represented in leadership positions. That, itself, has been exciting for me to see.
Again. I felt that I had great mentors who were women of color. That helped me to see that this is possible for me, that I can come up through the ranks in this field. But that’s not a common experience. One common scenario is that once a woman of color becomes a faculty member at a school of public health and once a woman of color attains a leadership position, that person get a lot of mentorship requests. That’s great to see, but it also indicates that there remains a huge demand for that kind of mentorship from new, entry-level professionals that was not previously being met, at least not by mentors who come from diverse backgrounds.
[OnlineEducation.com] What have your experiences as a mentor been like? What kind of advice to do find yourself offering to people who are new to the field?
[Dr. Narasimhan] I think people health is essential an applied field. So I advise student to think about spending some time working in the field between their MPH and their PhD degree, or between finishing their bachelor’s degree and starting an MPH program. There are a lot more MPH programs now and, as a result, students tend to do something similar to what you would do in the social sciences or the humanities: they feel compelled to go directly from their bachelor’s degree to a master’s or doctoral program. That works great for some people. But the experience of being in a working environment helped me to better understand what I was interested in doing within the field and it helped me to put into perspective the skills that I felt were important versus the skills that felt less important to me. It also gave me a bit of an out in the sense that PhD programs and this road through an academic life can be very difficult and very challenging. So having some work experience outside of academia can help your mindset because at least you know that the skills you already have can be put to use in the field.
I also encourage students to ask themselves what they think that getting a particular degree is going to allow them to do that they wouldn’t otherwise be able to do. There can be a tendency to look at a PhD as just the next thing that you’re supposed to do. I think I did that. I think I felt that I was a smart person who liked to read and who liked to write, so I should get a PhD. That was the right choice for me. But getting a PhD is a little bit like becoming a small business. So you have to ask yourself, do you want to run that business? Do you want to write grants? Do you want to create a scholarly niche? Do you want to teach? And how willing are you to sacrifice parts of your personal life and other interests in order to complete the degree?
These are the kinds of things I talk about with mentorship. There are other things that come up, like how do you have hard conversations with someone who you are working for, especially as a student? And there are the day-to-day challenges of creating a work schedule for yourself. These are regular things that freelances do but it’s important to think about what it’s like not to have a nine-to-five job and to have to create structure for yourself.
[OnlineEducation.com] You mention hard questions. What do you mean by that?
[Dr. Narasimhan] There are a lot of complex power dynamics between a student and a mentor. How do you push back and make your ideas shine and make them your own? How do you become and independent thinker and scholar? But then also, how do you decide when the argument is maybe not worth it and maybe your professor or mentor is right? That can be a difficult balance to strike.
I also think that academia and academic work can lead to mental health issues. So how do you cope with that? I talk with students a lot about that. There’s a perfectionism that comes with becoming an academic and that drives a lot of people in academia, which, along with pressures to produce great work and setting your own benchmarks, are all stressors.
So, a lot of mentoring is about connecting students to resources. As a mentor your take responsibility for students that you take under your wing. Whatever they ask you for, you’re trying to give them the best quality advice, which sometimes means pointing them in the direction of other resources.
[OnlineEducation.com] Getting back to your current work, specifically the research you’ve done looking into what happens when states limit access to reproductive health services, how important is it to have women active in this area from a research and policy perspective?
[Dr. Narasimhan] It’s important in public health in general. But in reproductive health, the stories of people’s experiences are extremely personal. And it is important to have these stories out there. We have seen that in legislative hearings where women are coming forward to talk about their personal and painful experiences. That can serve as an important injection of truth into these high-level legal discussions that often become very impersonal.
We did a paper on Georgia’s HB 481 bill that you’ve seen – the paper that I published with my colleague Dabney Evans that looks at anti-abortion testimony in the hearing over the bill. We have several other papers that are coming in which we look at proponents and opponents of the bill and then across states at other bills that are like this. What’s striking to me is the degree to which discussions about this personal issue can become very impersonal. As a result you have language like, “we should never have an exception for a fetal anomaly because it makes no difference when we define life.”
It’s clear that the circumstances and realities around some of these statements about pregnancy and abortion can be incredibly fraught. Having more women or, more precisely, having more people who can become pregnant in these conversations shines a light on the lived experience of going through of these difficult situations.
Another issue is that many the conversations surrounding these laws are just are not evidence based. That can be quite confusing to people who just hear snippets about these laws. One of the things we know about reproductive health and abortion is that the more knowledge that people have about the issues, the more likely they are to understand the nuances of reproductive health and to see that the regulations don’t map on to the lived experiences of people who have been through complicated pregnancies. Often in arguments about an issue like reproductive health there are nuances that make it difficult to discern whether or not something is factual.
One thing that we don’t have in the American legal system is a fact checker. But researchers are getting more involved in legal fights. We are able to do research that is then put into these dockets and then put on the record as evidence. That’s one of the things that is so great about applied research: the research can be used in these legal battles and we work with communities to research topics that are relevant to their needs.
That’s been the impetus for the kind of research that I have been engaged in. I was thinking a lot about online information and the role played by misinformation in some of these state-based laws and in the opinions of people in the general public. And I really credit my colleague, Dr. Evans, because both of us were at the hearing for HB 481 when it was in committee. We both noticed the same thing, which is that both sides are using similar arguments and sometimes drawing from the same research that nobody had systematically looked at.
[OnlineEducation.com] Did you testify?
[Dr. Narasimhan] I did not. A number of my colleagues from Emory were asked to testify. We all showed up prepared to be witnesses at the hearings, but the legislators get to decide who they want to call, and they don’t have an unlimited amount of time. Interestingly enough, one of the things that we’ve pointed out through our research is that there is a lot of room for specialty testimony outside of law, public health, and medicine about the truth and legality of these laws.
[OnlineEducation.com] What types of misinformation regarding reproductive health has stood out to you?
[Dr. Narasimhan] One of the best examples relates to the assertion that a heartbeat is the legal indicator of life. Very specific laws are used to establish this as fact. The truth is that the people pushing these bills have been very careful to only reference parts of the law that support their contention. The reality is that the law describes the need to have a heartbeat, brain activity, and respiratory activity as a legal indicator of life. In the case of fetal heartbeat statutes, what they are referring to is at the very beginnings of a cardiovascular system. That’s what you are able to hear at that point in a pregnancy. Many women haven’t even detected that they are pregnant at the point that that begins.
In addition, people call this a six-week ban on abortion when it’s actually more complex than that. Six weeks is generally the point at which flutter sounds can be detected, but it isn’t a true audible heartbeat that they are hearing, and it does not mean that the fetus can live outside of the pregnant person. Yet, this could be used to affect a full ban on all abortions in certain states because flutter detection can occur much earlier than six weeks.
That’s one of the assertions that gets made fairly often in these debates and it is not supported by medical evidence. ACOG – the American College of Obstetricians and Gynecologists – has already come out with statements against these bills and how potentially harmful these bills are. To continue to assert that there is medical evidence backing these bills is misleading and can be very confusing to people who don’t know otherwise.
Another problem is that once these bills are introduced, we’ve found that there are people who just assume that they are settled law and that not merely proposals that are still being debated. So you have people who just assume, based on the introduction of the bill, that the procedure is not available to them anymore.
There is also a lot of fear when these bills come into play because in many of these states it is already very difficult to access all kinds of reproductive health services. In Georgia, a majority of counties no longer have a labor and delivery unit anymore. So, women have to travel into another county, sometimes hundreds of miles, to access basic prenatal care. We have reached a point where there is a striking lack of understanding about how people actually live their lives and what they have to do in order to obtain basic healthcare services.
These disagreements that we have about abortion may stem from different moral and philosophical underpinnings. But what we do know from science is that abortion is a very safe procedure; it’s safer than childbirth. It’s a necessary and a common procedure. And it is still stigmatized in the US. Unfortunately, in the US the Hyde Amendment and internationally the “Global Gag Rule” (Helms Amendment), dictate funding policy. That’s why I was so interested in working at RISE. I hadn’t done abortion related work before I came here. And I’m not sure if I will continue to do this kind of work in the future. But I find it’s troubling situation when US politics cuts off access to reproductive health services for many millions of people globally.