Dear Doctor: Aviva Romm
The New York-based MD, midwife, and herbalist sheds light on existing disparities in women’s healthcare, her work with Sakara Life, and the biggest myths around hormonal health.
For the past thirty-five years, Dr. Aviva Romm has been an advocate in women’s and children’s health. From her work at a midwifery collective in Atlanta, to her work with Sakara Life, and her latest book on Hormone Intelligence, Dr. Romm has long been at the forefront of holistic women’s health.
Read on to learn how she started in medicine, how her experience witnessing the disparities in our healthcare system inspired her to go back to school, and she believes why food and nutrition are a crucial part of the integrative health model.
How did you get started in medicine and what inspired you to choose your specialty?
My journey to medicine was a bit unconventional. When I was a kid, I wanted to be a physician, and I went to college early — I was just 15. But in my first semester, I got exposed to what we would now call integrative medicine — though in 1981, it didn’t have a proper name yet. I fell in love with herbs and midwifery and food as medicine. So I left school to learn more about those things, which was really hard to do since there were hardly any books let alone medical journal articles on these topics at that time.
I practiced as a home birth midwife and an herbalist for about 20 years, starting long before the recent wave of popularity and interest in natural therapies. The landscape was much more polarized than it is now: Pregnant women had to choose between a very ‘outside the system’ approach with a midwife, or had to enter completely into the medical model, which was often inhospitable to those who wanted a more natural approach.
From early in my career, I also had a deep awareness of health disparities and issues of health access in the medical model. Eventually, I decided to complete the circle I started when I was 15 years old and return to medical school so that I could be a bridge for people who were getting mistreated or marginalized, and expand the access points for those who lacked access to respectful, equitable maternal health and medical care. I wanted to change the system from the inside out.
Your path to becoming a physician is a storied one — how did your 20+ years of experience as a midwife and herbalist help inform your knowledge of endemic racism and socioeconomic disparities in women’s healthcare?
I grew up in a housing project in Flushing, Queens — a community that, 55 years later, is still considered medically underserved. My family had to travel to another neighborhood in order to get medical care, my mom had to travel to another borough to have me, and so on. In that way, my entire upbringing was shaped by the way healthcare disparities affect our communities.
In my first semester at college, I became deeply involved in health and feminist studies, and the history of medicine in the US. This is when my eyes were first opened to the disparities in women’s healthcare. One glaring example was the Dalkon Shield. This was one of the early intrauterine contraceptive devices (IUDs). If you look at its history, you learn that there was not one single study done on human women (or even animal studies) before it was released into the common market. Then, a few months after it was released, they discovered that the IUD caused an array of severe injuries, including pelvic infection, infertility, and death. Yet it was used for many years after — the harms not being disclosed to the women who received it. When legal action was taken against the manufacturing company, reports were consistently ignored or minimized. Even when it was definitively proven that the Dalkon Shield was causing hemorrhages, infections, sterilizations, and death, and its sales in the US stopped, it continued to be exported to developing countries where Latinx and African women would receive it.
When I began to study midwifery, I learned of the disparities in how women are treated when they have babies: how they’re infantilized and sometimes not treated with full human rights. This was in the early 1980s, and, for example, forced hysterectomies and forced sterilization were still legal in some states, including California. Latinx and Black women were subjected to these procedures, often told during vulnerable moments in labor or right before going under anesthesia for a cesarean that this was an option they should accept. Sometimes, however, these women were not even given the option, and they would wake up only to discover that a hysterectomy had been performed while they were under anesthesia, with absolutely no consent given.
Do you have a personal experience of witnessing this disparity from your time as a midwife?
In Atlanta, I was an apprentice to a midwifery collective that is one of the oldest black midwife collectives in the United States — my teachers are considered the grandmothers of the black midwifery movement.
I remember one profound experience with a Black pregnant mama who was planning to have a home birth. One day, around 8 months into her pregnancy, she suddenly began having severe abdominal pain so went to one of the hospitals nearby where she happened to be when the pain began. This was before the day where if you were in labor or had an emergency, the hospital had to take you regardless of skin color or whether or not you had insurance. She was denied care at this wealthy private hospital and had to travel across town to the inner city hospital instead. By the time she arrived, her uterus had ruptured and the baby had died. Thankfully, she survived, but this was a moving case that really illuminated health disparities for me.
Recently, I gave a talk to the Georgia State Legislature week on this very issue. Forty years later, Atlanta, Georgia still has the highest infant mortality rate and one of the highest maternal mortality rates in the United States — with the most staggering impact in the black community.
Not to mention, midwives are still illegal in the state of Georgia — a precedent that is historically based on systemic racism. Most midwives in Georgia, up until the 1920s, were black. When the American Medical Association (AMA) formed there, they systematically eradicated home birth midwives — ie, the black midwives. And it’s remained illegal ever since.
I think my experience being an illegal midwife in Georgia was a big part of what pushed me to go back to medical school. Had I practiced in a state where midwifery was legal and well supported, I might not have seen or experienced the disparities in the same way. But having those experiences gave me the fire to speak up and work to change the system from the inside out. And that’s what I have done.
Tell us more about your passion for integrative medicine. How do you think its tenets — specifically nutrition — can help improve the everyday person’s access to better health?
The central idea behind integrative medicine is that you are a whole person, meaning if you have diabetes, you’re not just a number on a glucose test. You’re a whole person with a multitude of health factors, from your genetics to your access to care to the diet you eat and the stress that you’re under. We know that all of these factors can contribute to the formation of a disease.
Food, in particular, plays a huge role. To me, food is really the first medicine. We know that whether or not we have the right nutrients determines how well our bodies function and how well our immune systems work. Further, our microbiome is dependent on the food we eat and its effect on our immunity, our cognitive function, our hormone balance, digestion, our ability to assimilate nutrition, is immense.
But food can also be a vehicle for things that harm us. Whether that’s herbicides and pesticides, plastics in our food that come from food packaging, or pharmaceuticals, antibiotics, and heavy metals that accumulate in animals or fish, the food that we eat and can also have a harmful or adverse effect on our health.
Thankfully, food is also one of the easiest things for people to change. Even within food apartheid, we can help people to make better choices for themselves. Whether that’s encouraging people to buy fresh juice instead of soda, whole grains instead of denatured white bread, or simply buying fruit and vegetables instead of processed foods, changing our food habits can provide positive results quickly.
Let’s talk about your work with Sakara Life. How do their food principles align with yours?
I’m a scientific advisor for Sakara (not a paid relationship), and a lot of their principles are aligned with the principles that I share with my patients and the principles that I personally live by.
It starts with thinking about food as nourishment and information rather than food as calories. Most of us, especially women, develop stressful relationships with food over time. Thoughts like, “is this food gonna make me fat?”, instead of, “is this food nourishing me?”
To put the nourishing framework into context, let’s consider artificial food. Probably not very nourishing, right? From an evolutionary standpoint, our bodies don’t actually know what to do with a lot of those artificial and synthetic ingredients. But when you give your body blueberries, your body knows what to do with those blueberries.
Like Michael Pollan once said: “Don’t eat anything your great-great-grandmother wouldn’t recognize as food.” It’s a simple but really important way of redefining our relationship to food.
Another Sakara principle is prioritizing a plant-based diet. While there’s no pressure to go full vegan or vegetarian, there is an important emphasis on getting most of our nutrition from fruits, vegetables, whole grains, legumes, nuts, and seeds. And when we do that, it’s not just unquestionably better for the planet, it’s also better for our health. We know that those who eat primarily plant-based diets have better nutrition, healthier microbiomes, less diabetes, less cardiovascular disease, and less cognitive impairment and dementia. As we get older, plant-based diets also support better fertility, less endometriosis, less PCOS, and healthier periods. Unequivocally, plant-based diets have been documented as the healthiest way to eat — and healthiest for the planet.
Your newest book, Hormone Intelligence, comes out this year. What are the biggest myths you hear circulating in the wellness world regarding women’s health and hormones?
One of the biggest myths is that our diagnosis is our destiny, or that we have no control over our menstrual or gynecologic health. While yes, we do need to shift tthe expectation that if we do everything right all of the time, we’re going to have “perfect” menstrual cycles and will never have hormonal issues like endometriosis, acne, or fertility problems. That kind of thinking puts a huge burden on women to fix things that are not just a result of our diet or stress levels, but often due to much bigger factors than that, like environmental exposures, socioeconomic pressures, and even medication exposures we had when we were kids — like the overuse of antibiotics.
But we can have a tremendous impact on our hormonal and gynecologic health by making small but important shifts that reduce inflammation, provide our bodies with the nutrients we need for hormone health and balance, and learning how to reconnect with our cycles and engage in a whole new relationship with our hormones and our lifestyles.
You’re a fierce advocate of women’s healthcare rights. Research shows that female pain is still greatly disregarded in clinical settings and that black and indigenous women are two to three times more likely to die from childbirth than white women. What are some of the other significant disparities in women’s healthcare today?
Unfortunately, there are many. One disparity that’s often overlooked and under-addressed is the fact that most research conducted is not focused on women’s health. To this day, 70% of pharmaceuticals are taken by women, but historically, almost all of the research on pharmaceuticals has been done on men. Men and women have different metabolisms, require different doses, and absorb medications differently, especially during different times of the menstrual cycle — so this is a huge issue.
Another disparity has to do with the clinical diagnosis of endometriosis. A few years ago, a study found that between 63% and 70% of primary care doctors self-stated that they were unable to name any symptom of endometriosis beyond abdominal pain and pain during sex. And that same number of doctors said that even if they were able to diagnose endometriosis, they would have no idea how to treat it. Endometriosis affects at least one in ten women, so that’s also a huge disparity.
There’s also a huge disparity around sexism and body shaming in medicine. Women aren’t just fat-shamed by their physicians, but in the wellness world, too. In the clinical space, this disparity negatively affects patient outcomes, as larger patients are less likely to seek care for fear of receiving abuse from their physician. And when they do see their doctors, they’re less likely to receive quality care.
Finally, there’s a significant disparity when it comes to how women with pain are treated. Research shows that when a woman goes to the hospital reporting chest pain, she’s more likely to be given anxiety medication. But if a man goes to the hospital reporting chest pain, he’s more likely to receive a workup for a heart attack, even though the woman is just as likely, if not more likely, to be having a heart attack. And that kind of bias happens across the board with pelvic pain and endometriosis pain, too.
There are also some studies that show that women receive better or worse care based on their physical appearance at the doctor’s office. Specifically, if a well-dressed woman goes to the doctor’s office and reports pain, she’s less likely to be believed and treated, the thought process being that if you have the time to put on makeup, there’s no way you can be in pain. On the other hand, if a woman who isn’t dressed well or comes in looking disheveled mentions pain, she’s unlikely to receive care because her appearance suggests that she’s drug-seeking. And Black women are even less likely to get appropriately treated if they have pain — regardless of how they’re dressed.
As a result, women with chronic pain have had to learn to adapt these behaviors and appearances just to get proper treatment.
What do you think can be done to provide better gender equity in healthcare?
We have to go deep into the medical curricula to look at both racial and gender biases and start by teaching medical students to address and identify them — especially white male medical students.
Our medical curriculum needs to go beyond learning about anatomy and pharmaceutical and surgical inventions to help future doctors learn how to talk to patients and how their own human individual biases affect the care that they give. We have to bring in the work and teaching of sociologists and experts like Dr. Loretta Ross, one of the foremothers of reproductive justice, to unpack and improve our medical curriculum, and Kimberly Crenshaw, who introduced the concept of intersectionality in black women’s lives, into the medical curriculum.
From there, there has to be a willingness to admit what’s happening. We know that people who are cared for by women in hospitals are less likely to die. We also know that black babies taken care of by black physicians are less likely to die than may be taken care of by white physicians. So, how do we start to address and unpack these statistics?
To make things even trickier, women going through medical training sometimes have to adopt some of the “dominator” behaviors just to get through the system. So there needs to be a checks and balances system where trainees can check in with themselves and say, “is my empathy going down?” or “am I becoming biased?” Because we know that our empathy and compassion levels go down over the course of medical training — but both are crucial to providing quality care to our patients.
It’s clear that we have a lot of work to do, but I feel hopeful that we’re headed in that direction.
Vital Signs
How do you unwind after a stressful day? My favorite thing to do is put on loud boy band music or Joan Jett and dance-it-out with my hula hoop! I also love spending time in my garden, so I guess it depends on the season!
What can you tell us about the importance of the right prenatal vitamin? Having a prenatal vitamin that provides the optimal complement of nutrients for mom and baby helps to ensure that mom and baby are going to be healthier, have less risk of miscarriage, less risk of preterm labor, and less risk of depression. Plus, the right prenatal vitamin helps give the baby an optimal start at growth and cognitive function. Though mom can get a lot of the nutrients she needs from food, the right prenatal vitamin can offer valuable peace of mind, in addition to the more subtle nutrients she and baby need.
Any tips to make distance learning more fun for our kids? Don’t expect your kids to keep the same classroom hours when they’re sitting in front of a computer. Make space for lots of breaks, creative tasks, and movement throughout the day.
What’s one healthful habit you’d love to see patients — especially female patients — adopt? Spend less time on social media, particularly in the half-hour after they wake up before they go to sleep. It leads to a lot of doom scrolling, stress, comparison, and FOMO. Also, find a form of self-care that you love and make it non-negotiable. We all need a little time to ourselves, even if it’s just once a week.
You can learn more about Dr. Aviva Romm here.
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