“We’re in a situation now where our system is broken for women, and particularly women of color. People want midwives and can’t get them because their insurance doesn’t cover it or there is no one in their community,” says Dr. Tanya Khemet Taiwo, noting that 30% of U.S. counties have maternity care deserts. This means needing to drive three or more hours to get care.
Dr. Taiwo has spent most of her career working as a midwife in public health and community clinics. Recently, she moved away from teaching and research to focus on philanthropy for birth justice. She’s working to support a midwifery model of care: increasing access to midwives, diversifying the workforce, and building the systems to reduce maternal health disparities. Meanwhile, widespread government funding cuts are currently upending many of her colleagues’ work–research she relies on for her own.
“Rural hospitals are closing their labor and delivery units because they can’t survive in the current system. Imagine if we were able to strategically place birth centers in rural communities?”
Project TENDR
As she endeavors to transform the health care system to integrate midwifery care, Dr. Taiwo has a front row seat to science in America being undermined, defunded, and disregarded by the Trump administration in her ongoing role as co-leader of Project TENDR, a “unique collaboration of clinicians, scientists, and advocates” working together to reduce exposure of neurotoxic environmental chemicals in pregnant women and children. TENDR stands for “targeting environmental neuro-development risks.”
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Dr. Taiwo helped launch Project TENDR about a decade ago. She and a few others identified and acted on a need to bring together colleagues who were otherwise siloed in their overlapping work. “Because of my time working with communities of color, I remember that when we would have a child with multiple congenital anomalies, most of the time it was a recent Mexican immigrant. I know this is environmental in my heart. That’s how I got involved.”
She discussed these environmental exposures, including how they exacerbated maternal stress, with Project TENDR co-founders Dr. Irva Hertz-Picciotto, her then dissertation advisor, and Maureen Swanson, who was at the Learning Disabilities Foundation at the time. “We said, ‘We need to get the scientists together with the advocates.’ That’s how it started. I joined on,” she recalls, adding, “Scientists talk to scientists about things like phthalates and pesticides. And you have the clinicians seeking the impacts and the advocates working to try to impact the decision makers. Project TENDR is an opportunity to bring everyone together.”
One of the first things the collaborative group did was to look at the five chemicals that have the most solid evidence of impact on the developing brain. “We wrote a consensus statement that briefly summarized the science—and also came from the advocates and the clinicians. We laid out very clear recommendations about how to reduce exposures to these various chemicals,” she explains. Since then, members of Project TENDR, including Dr. Phil Landrigan, pediatrician and public health physician, and Dr. Linda Birnbaum, toxicologist and former Director of the National Institute of Environmental Health Sciences, have published multiple articles in peer-reviewed journals.
Shifting focus
All members of Project TENDR meet annually to decide on their focus for the upcoming year. This year’s meeting will take place in November. Chances are there will be a lot of talk about gutted funding and an Environmental Protection Agency that wants to protect industry, not public health. Recent areas of focus include disparate exposures and how mercury is being concentrated in children of color who are under five. “That’s a pure science paper using blood urine mercury levels as well as end gains in the National Health and Nutrition Examination (NHANES) Survey, a national survey of adults and children. They collect all kinds of bodily samples and are able to track those exposures.”
This data is critical in helping Project TENDR members identify the outcomes of practices like dental clinics being required to use mercury amalgams. “The Indian Health Service is still using mercury even though the FDA has said don’t use it; there are alternatives.” Poor children suffer. Dr. Taiwo hasn’t heard that the NHANES Survey has been defunded. “But it’s only a matter of time,” she laments. Much will be lost if this data isn’t widely available in the future.
Project TENDR members have also written a briefing paper on the World Plastic Treaty that they “put into the hands” of Biden administration negotiators. “Until they saw our briefing paper, they didn’t have health on their agenda. We are laser focused on neurodevelopment, but once you think about the brain, you do think about other organs impacted by toxicants,” she says. That paper was narrowed down to a commentary article now under review. “We want to ensure people understand that the fossil fuel industry is recognizing that the writing is on the wall. People love their electric cars and so they are shifting into plastics.” What else to do with all of the unused gas?
The role of science
Because Project TENDR is small and runs on volunteer effort, it’s safe from widespread funding cuts—for now. Working in a collaborative group doesn’t always mean working with colleagues entirely aligned on every topic. “One of the beautiful things about Project TENDR is we wrestle with a lot of stuff. We have people who believe different things. At the end of the day, it’s about the science. Is the science fully credible?”
But today a newer and much bigger question looms: “When junk science becomes the norm, how do you even work with an EPA that doesn’t actually care or understand science?”
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