Breaking Barriers: Lumen Scholar Deena Elrefai ’22 researches reproductive health of Latinx women in Alamance County

Public health and international & global studies double major Elrefa and with her mentor, Associate Professor Stephanie Baker, focus their Lumen Prize research on disparities among the Latinx community and reproductive health.

Most times when Elon students are interested in the Lumen Prize, they have already selected a specific topic they want to delve into and a specific faculty member that want to work with.

That was not the case for Deena Elrefai ’22.

“I had a bunch of things I was interested in,” Elrefai said, a public health studies and international and global studies double major. “I knew I wanted to work with women. I wanted to work in public health. That was all I really knew.”

Looking to get into undergraduate research early, Elrefai had several ideas she wanted to tackle from an international context. But once paired with Stephanie Baker, associate professor of public health studies, she narrowed down her potential topics to the history and HIV among Black women or menstrual health of Latinx women in the United States.

“Dr. Baker has worked with a lot of women in lots of community groups here. She does a lot of local community activism and that was really interesting to me,” Elrefai said. “She is amazing.”

Baker presented Elrefai with substantial literature on both topics. “Even though there was more data on Black women and HIV, I was more drawn to the topic of reproductive health in Latinx women, and we ended up in that area,” Elrefai said.

“She read those, and she came back really interested in thinking about what it means to address health inequity through an antiracism lens,” Baker said.

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Working with Latinx women would also be more applicable to Alamance County compared to the epidemic of Black women disproportionately suffering from HIV, which was more prevalent in cities such as Washington, D.C. and Atlanta. With a minor in Spanish, it was also exciting for her to work with a population with which she could communicate in their native language.

The pieces came together to put Elrefai on a path toward becoming a Lumen Scholar. The Lumen Prize awards scholars a $20,000 scholarship to support a chosen research project and allows them to work closely with a faculty mentor on that project for two years. Each year, 15 rising juniors are named Lumen Scholars and conduct research that often produces conference presentations and publications.

Elrefai’s project, “Latinx Reproductive Health: Dimensions of Diversity and Impact on Healthcare Engagement,” centers on the barriers the Latinx community face towards reproductive health in the United States and Alamance County.

Reproductive health care is instrumental in healthy birth outcomes. The infant mortality rate for Latinx people in the U.S. is five per 1,000 live births compared to 4.7 for non-Hispanic white infants.

This relatively healthy rate masks the fact that within the Latinx community, Puerto Ricans face a significantly higher rate of fetal death at 6.5 per 1,000 live births. Among Mexican American women, a different study of births found that infant mortality was 2.5 times greater among women who did not receive prenatal care.

“We sometimes lump all Latinx communities together and when we do that, we miss out on how some communities may be doing worse than others,” Baker said.

Elrefai and Baker’s study will use a qualitative methodological approach and collect data through focus groups from subsets within the Alamance County Latinx community to better understand differences in reproductive health care experiences, and in turn how to address these discrepancies the Latinx population encounters far too often.

Focus groups will be centered on a variety of reproductive health interactions and occurrences including patient/provider communication, fetal health and fetal death.

Initially, the focus of the project was on prenatal care. But as they gained information and began speaking with community partners, they discovered there were a lot of disparities around reproductive health in general.

“One of the first things I had her do was reach out and meet with some of my community partners to see whether or not they thought her research ideas were of importance and could be of use to the Alamance County community,” Baker said. “She was very meticulous about doing that and they told me they were really impressed and were really excited about her research ideas.”

Areas such as contraceptive access, pre- and post-natal care, abortion access, the influence of religion and demographics are just some of the factors that played a role in the disparities they found.

“This specific study is focused on understanding how different demographic indicators like race, country of origin, language, socioeconomic status, education play into people’s ability, agency and self-efficacy to engage with health care systems in Alamance County — more specifically in the Latinx population here,” Elrefai said.

For her research, Elrefai would work with a community advisory board made up of seven women from Alamance County, each coming from a different background and each having different involvements within the local Latinx community.

“They have been an integral part of my research throughout the process, and they have provided me with fantastic feedback from developing my topic all the way through community dissemination of the research. I’m so grateful for their support and I can’t imagine doing this process without them,” Elrefai said.

Another primary focus is the disaggregation of the term “Latinx” to understand how all those factors will influence someone’s ability, interest or engagement with health care systems. Black women face the worst maternal mortality outcomes of anyone in the U.S., while Latinx women fare rather well, Elrefai said. It is when all Latinx people are broken up by country of origin that the disparities are spotlighted.

The term “Latinx” encompasses over 20 countries, dozens of languages and over 100 ethnicities and it is unlikely to get accurate data or proper treatment when they all are combined.

“’Latinx’ could mean someone whose family got here 200 years ago and has a Cuban ancestry and it could be someone whose family arrived yesterday and they’re going to have very different experiences,” Elrefai said.

As her mentor, Baker said she has seen Elrefai become more independent as a researcher. Working on projects with various moving parts is not a small task. That, along with a global pandemic that hindered recruitment for the project, could discourage someone else. But Baker said that Elrefai stayed committed to the project and adjusted along the way

“Deena became very independent in running those community advisory board meetings by herself. When someone was identified that didn’t speak English, Deena started hosting her meetings in Spanish,” Baker said. “It was lovely to see her grow into that.”

Elrefai said she’s excited that her research will have a local impact. Elon is a university that hangs its hat on its international prowess, and rightfully so, but with so many gratifying possibilities nearby, it’s important to focus on those local stories as well.

“Elon itself is a global university, as we like to say,” Elrefai said. “But I think that takes away some of our opportunities to engage meaningfully right here. There’s so much rich social context here that we often don’t interact with or address or know about.”

Learn more about the Lumen Prize and other Lumen Scholars here.