Karen Scott, MD, MPH

At the University of California, San Francisco, Karen A. Scott, MD, MPH, FACOG is an Associate Professor and OBGYN Hospitalist in the Department of Obstetrics and Gynecology. As a sexual, reproductive, and perinatal (SRP) epidemiologist and obstetric hospitalist, the ethics and science of her research, clinical practice, and teaching exists at the intersections of critical, interpretative, cultural, and biomedical anthropology and crunk public health, with a foundation rooted in Cultural Rigor, Black Feminism, and Reproductive Justice (RJ).

As a "dissident, disruptive, and recovering" board certified OBGYN and critical public health scholar, her work examines interventions to eliminate and reduce disparities and inequities in SRP health services provision, through the integration of a Black Feminist and Reproductive Justice (RJ) Praxis , in the afterlife of slavery and passage of the Congressional Act of 1807 (which took effect in 1808, prohibiting further participation of the United States in the slave trade.). A Black Feminist-RJ Praxis informs the ethical considerations, theoretical concepts, methods, and methodologies in her participatory research, practice, pedagogy, and policy analysis. She examines health service provision in antepartum, intrapartum, and postpartum units as sites through which racism (structural, gendered, and obstetric) can be understood, described, measured, and modified within patient-clinician, patient-system, and community-system interactions, across time, place, and levels of power in the following continuum of care: clinical cognition, assessment, diagnosis, service provision, and decision-making processes. Her research also examines the role of gendered racism, power, and economics in the authentic, coerced, and regulated formations and expressions of Blackness, Black womanhood, Black motherhood, Black births, and Black women's scholarship within hospital and health systems culture, organizational structures, and operating mechanisms.

Inspired by Marshall, Pronovost, and Woods 2013 critical paper on the Promotion of Improvement as a Science and Deming’s System of Profound Knowledge (epistemology, variation, systems, and psychology), her participatory equity and justice based QI research aims to interrogate and dismantle traditional QI projects that rely on “contemporaneous, non-standardized unverified data to make judgments about their effectiveness” using atheoretical methods, at the exclusion and erasure of the wisdom and voices of the most impacted, marginalized, and minoritized patients, practitioners, and scholars. Her secondary research aim is to describe and amplify local wisdom and transferable knowledge with robust participatory research methods grounded in Cultural Rigor, Black Feminism, and Reproductive Justice, in order to facilitate local improvement in health systems and construct knowledge with external validity for, by, and with Black mothers, birthing, women-led/serving community-based organizations, and women scholars. The implications of her program of participatory QI research are three fold: 1) formation of authentic, affirming, and autonomous partnerships among community partners, patients, academic scholars, practitioners, payers, and policy makers; 2) theory of change development and clarification representing epistemological diversity from health services research, clinical epidemiology, medicine, nursing, public health, social sciences, humanities, bioethics, and legal studies; and 3) translation of participatory QI science into SRP health care services provision, interprofessional education, and policy at the local and national level.

As an educator, she examines the approachability, acceptability, availability and accommodation, affordability, and appropriateness of individuals, institutions, and systems in public health and health care that have traditionally rendered marginalized voices and communities invisible or invaluable as decision-makers, generative thinkers, achievers, and connectors. As a clinician scientist, she works to build individual and system capacity to challenge the hierarchy of knowledge production and dissemination as well as the decision making that sustains the medical industrial complex and perpetuates social and health inequities.

As the Principal Investigator of the SACRED Birth Study, she has defined three theoretical frameworks with the foal of redesigning perinatal QI through community driven measures, meanings, and methods: 1) sacred birth; 2) participatory QI research (QIR); and 3) participatory patient reported experience measure (PREM) of obstetric racism in partnership with Black birthing mothers and birthing people, Black women-led community based organizations, Black women scholars, and other scholar allies and accomplices, recently published in a public platform for greater accountability and dissemination to the public we serve.

She has also examined the role of philanthropy in advancing cultural arrogance, philanthropic redlining, and community harm in addressing the perinatal health crisis in the United States. In response to the crisis, she has described four modalities of cultural rigor and offered recommendations on the operationalization of cultural rigor, reproductive justice, and Black feminism for funders, grantees, research teams, and QI experts.