Championing Maternal and Newborn Health: The Work of Dr. Sydney Spangler

Spangler fights for safe and equitable care for mothers and babies alike, from the classroom to across the world.

By Diyya Ganju

It’s a cold, crisp morning in Atlanta. At 4:00 AM, it seems only the birds are awake — and Dr. Sydney Spangler, an Associate Professor at the Nell Hodgson Woodruff School of Nursing at Emory University. She is already deeply immersed in a Zoom call. A Tanzanian nurse on the screen explains the latest results from a hospital’s new maternal health information system that Spangler helped implement. Spangler has an answer for every problem, demonstrating the energy she has brought to the projects she works on.

Spangler’s passion for global health started at the age of 20, when she decided to pool her savings to study in Guatemala. She hadn’t confirmed that she had a spot at the school she was planning to attend and didn’t even have a place to stay, but she knew she could make the situation work. “A lot of this stuff is luck. It’s like recognizing an opportunity when it comes along and saying yes,” says Spangler.

This philosophy encapsulates Spangler’s career, where technology, policy, and passion intersect. Her work has redefined approaches to maternal and newborn care in under-resourced areas of East Africa, particularly in regions grappling with systemic healthcare challenges. She has leveraged text message interventions for HIV-positive mothers and reshaped international standards for skilled birth attendants to revolutionize how healthcare is delivered—and how success is measured.

Journey to Research

Spangler was born and raised in Salt Lake City. She graduated from the University of Utah with a bachelor’s degree in anthropology but debated what her next steps would be. The struggle over attending graduate school to pursue public health or going to medical school ended with her graduating with a second bachelor’s degree in nursing. Following this, Spangler attended the University of North Carolina at Chapel Hill, where she completed her PhD in Maternal and Child Health and Anthropology in 2009.

She received a CDC fellowship during her doctoral studies to work on a maternal health dissertation project in Tanzania. This opportunity marked a turning point in her career. Spangler not only worked on critical health initiatives but also immersed herself in the culture, learning Swahili and building relationships that would inform her research for years to come. “Most of my work since then has been in Africa and East Africa because of my dissertation,” says Spangler.

Spangler has worked as a professor at Emory University’s Nell Hodgson Woodruff School of Nursing since 2012. Her secondary appointment is in Emory’s Rollins School of Public Health. Spangler has helped communities ranging from rural Georgia to sub-Saharan Africa and Asia during her career as a nurse midwife, educator, and researcher. Her combination of clinical knowledge and experience, along with her academic credentials, has allowed her to shape her work environment and research questions across many disciplines.

Harnessing Technology for Maternal Health

One of Spangler’s most notable contributions to global health is her innovative use of technology to increase access to care. She piloted a text messaging intervention in Kenya called Option B+ designed to support pregnant and postpartum women living with HIV. The program provided women with vital health reminders, emotional encouragement, and a direct line to healthcare providers.

“Prior to that, so many felt that if women disclose their status, some terrible thing will happen to them,” says Spangler. “Most people were very well supported by their partners, families, and friends, and they were able to get better care without having to hide in shame and secrecy.”

The results of the study were transformative. Women who participated reported better adherence to HIV treatment and improved health outcomes for themselves and their babies.  The intervention not only improved medical outcomes but also fostered social support networks for participants by addressing stigma and promoting openness.

The study also underscored the potential of simple technological tools to bridge healthcare gaps in resource-limited settings. Such tools can serve as lifelines for vulnerable populations,enhancing access to care and empowering individuals to take control of their health.

Spangler’s emphasis on long-term impact and community ownership ensured that the intervention’s benefits extended beyond the study’s timeline, leaving a lasting mark on maternal and child health in the region. Eliud Akama, a Kenyan clinician and public health practitioner who collaborated on the study, praised Spangler’s approach for its cultural sensitivity and sustainability. “She acknowledged her role as a visitor. All of her changes, she made sure they would remain in effect after she was no longer there to oversee,” Akama says. 

Redefining Standards for Skilled Birth Attendants

Spangler’s work extends beyond technology into one of the most critical yet under-appreciated aspects of maternal health: the role of skilled birth attendants (SBAs). These are health professionals who have the competencies and training to provide care during pregnancy, childbirth, and immediate post-birth period. The presence of an SBA is crucial for ensuring safe deliveries and improving maternal and neonatal health outcomes, particularly in settings with limited resources.

This goes hand-in-hand with emergency obstetric care, a set of critical medical interventions provided to women experiencing life-threatening complications during pregnancy, childbirth, or shortly after delivery. These services address conditions like severe bleeding, obstructed labor, pre-eclampsia, infections, and unsafe abortion complications. Access to emergency obstetric care is vital for reducing maternal mortality, particularly in low-resource settings, where timely and effective care can mean the difference between life and death.

Spangler led another study in rural Tanzania evaluating the adequacy of global SBA and emergency obstetric care standards when applied to local contexts. The findings were stark: international indicators often failed to capture the realities of resource-limited healthcare settings.

“There was a raging debate about how we should structure maternal healthcare. Should we be looking at SBA and definitions? Or emergency obstetric care? I noticed neither was defined very well. What is a skilled birth attendant, what is basic obstetric carte, what is emergency obstetric care, and how do we define these things?” says Spangler.

Her work looked at how global standards for skilled birth attendants and emergency obstetric care often misrepresent the nuanced realities of rural healthcare systems. She uncovered the limitations of these metrics in accurately reflecting the skills, adaptability, and resourcefulness of local health workers through an in-depth study in Tanzania’s Kilombero Valley.

She found that the definitions of SBAs and Emergency Obstetric Care used by global health agencies were often too rigid and failed to capture the quality and scope of care provided in these settings. Many health workers who lacked formal SBA credentials still performed lifesaving procedures, while those meeting the criteria sometimes lacked the resources to deliver effective care. The study highlighted the need for flexible, context-sensitive metrics that prioritize the actual capabilities of healthcare systems, rather than adherence to uniform global standards. Spangler’s findings highlighted the need for localized, context-specific metrics to evaluate maternal health systems effectively, challenging the one-size-fits-all approach often imposed by international agencies.

“Knowing that traditional midwives and community members can be a valuable part of the birthing process, that’s what she really highlighted. It’s something that is so overlooked these days,” says Anjili Hinman, founder of the Atlanta Birth Center.

In The Classroom

Dr. Spangler taught “Stigma and Health” for the third time in Fall 2024. The course builds on her background in medical anthropology, allowing her to integrate key concepts about how stigma serves as a fundamental driver of health inequities. Previously, she taught a specialized medical anthropology class, but “Stigma and Health” offers an opportunity to explore these ideas in greater depth and with broader relevance.

This semester also marks the first time the course is open to all students. Previously tailored for midwifery students, the closure of the midwife program prompted her to redesign the class, making it accessible to a wider audience. Students from diverse disciplines now bring fresh perspectives to the class, enriching discussions and broadening the course’s impact. She is also exploring new opportunities to expand her teaching reach, including discussions with the Masters in Development program about possibly teaching classes to their students next year. “I’ve had to tweak it a little bit, but it’s been great to see it resonate with more people,” she says. 

For her, teaching is about exposure—not just for students, but for herself. Through her classes, she has the chance to meet a wide variety of faculty and students, enriching her own perspective, sparking new ideas, and creating meaningful academic connections. “Every class I teach helps me learn just as much as my students do,” she reflects.

Looking Ahead

Dr. Spangler’s next steps reflect her deep commitment to ethical practice in global health and her evolving interests in capacity building and policy work. 

“Research is fun and creative, but it’s fraught with ethical problems when people like me are doing research in places like Africa,” she explains. Spangler has shifted her focus toward empowering local researchers, instead of pursuing her own projects. “I’d rather support people who live in these communities to do their own research,” she says, aligning her efforts with broader conversations at Rollins about decolonizing global health.

Spangler is critical of a common dynamic in global health, where researchers from high-income countries extract data from low-income communities, publish papers, and advance their own careers without necessarily benefiting the communities they study. This realization has led her to prioritize capacity building over career advancement, focusing on providing resources and support for local partners. “I’m not here to advance myself. I’m just trying to be a good partner,” she says.

Policy work has also become a key interest for Spangler, particularly because of its transformative potential. However, she firmly believes that effective policy must be led by the people it impacts. “Policy touches all of our lives,” she says. “It has the potential for both positive and negative change in people’s everyday experiences.Government policy needs to be done by citizens of that country.”

As for the future, Spangler remains undecided but open to new directions. She’s considered leaving academia for the NGO sector to focus on capacity building full-time, returning to clinical work, or expanding her involvement in global policy. For now, she continues teaching courses she loves and working on her project in Tanzania. “Sometimes I think about starting a completely new chapter,” she says. “But for now, I’m okay staying here and figuring it out.”

Dr. Spangler’s journey reflects her dedication to ethical global health practices, capacity building, and impactful teaching. Her work challenges traditional paradigms, advocating for community-driven solutions and localized leadership in research and policy. Spangler’s focus remains on fostering equity and sustainability, whether it’s through mentoring students, supporting local researchers, or shaping the discourse on decolonizing global health. She is committed to ensuring that her work benefits the communities she partners with, prioritizing long-term impact over short-term accolades. As she continues to explore new paths—whether in academia, policy, or the NGO sector—her commitment to meaningful partnerships and transformative change remains steadfast. For Spangler, the goal is clear: to leave a lasting, positive impact on the communities and systems she engages with, while inspiring the next generation of global health leaders to prioritize ethics, collaboration, and inclusivity in their work.