By: Faith Jeffcoat

“I’m working every day to transform women’s health care in one of the highest areas of need in our country,” says Dr. Nina Ragunanthan, an ob-gyn provider in the rural Mississippi Delta.

Dr. Ragunanthan, a Magee alumna, is at the forefront of changing care for her patients. Disparities are present in health care across the country, but the Mississippi Delta is an area where the inequities nested within the health care system are particularly evident. She addresses these issues by creating tangible change for her patients, guided by a belief in health equity — where providers aim to address longstanding social determinants of health in clinical settings.

From Passion to Profession

Dr. Ragunanthan’s passion for global health grew from her educational experiences. While attending Duke University to study global health and health care disparities, Dr. Ragunanthan participated in the Robertson Scholars Leadership Program, a program dedicated to developing leaders in service to society. She served one summer with St. Gabriel Mercy Center where she ran a summer camp for children in Mound Bayou, Mississippi. During her studies at Harvard Medical School, she continued to participate in global health equity programs — including working with Partners in Health in Rwanda, an organization co-founded by Paul Farmer, one of Dr. Ragunanthan’s role models.

Through this education and outreach work, Dr. Ragunanthan fell in love with obstetrics and gynecology. When considering residency programs, she sought a place that would provide top training for generalists. She was thrilled to match with UPMC Magee-Womens Hospital, where she completed her four-year residency. While at Magee, she also spent time in Kenya with Dr. Jennifer Makin, an ob-gyn specialist at UPMC Magee, through a global health rotation as a third-year resident.

After completing her time at Magee, Dr. Ragunanthan and her husband Dr. Braveen Ragunanthan, a primary care pediatrician, decided to return to an area where they could address health care disparities head-on: the Mississippi Delta. “We had fallen in love with the Delta while in college, and we both felt called to serve this incredibly high-need area,” says Dr. Ragunanthan.

Addressing Disparities at the Delta Health Center

Dr. Ragunanthan is the sole ob-gyn provider at the Delta Health Center (DHC). The DHC is the oldest federally qualified health center in the country and has a rich legacy of addressing social determinants of health and supporting the needs of the community — regardless of the ability to pay. The DHC is in the heart of the Mississippi Delta — an area with a severe physician shortage and with that, a severe lack of subspecialty services. According to a report by NPR, the Mississippi Delta is a “Maternity Care Desert”, as many of Mississippi’s counties do not have obstetric hospitals, birth centers, or obstetric providers.

Working in a close-knit community offers continuity with patients — something that is hard to maintain in mainstream health care. “I get to know my patients and their families well. A lot of the time I get to work with multiple generations, which is rewarding.”

Dr. Ragunanthan credits her residency at Magee for helping her prepare for this role. “I use the training that I got at Magee every day, especially my training in high- risk obstetrics. I really value that training as someone who is now taking care of a lot of very high-risk pregnant patients,” Dr. Ragunanthan says. She also values her gynecologic surgery training immensely, adding, “I am the only ob-gyn at my hospital that performs laparoscopic hysterectomies.”

Dr. Ragunanthan also notes, “In addition to the training, I still rely on my Magee community for advice on cases. As I am the sole ob-gyn provider at the DHC, I don’t have that local support.”

Improving Access for Patients in the Clinic and Community

Though there are many areas to tackle in driving for more equitable health care in the area, Dr. Ragunanthan focuses on one tangible action at a time that can create lasting systemic change.

“My biggest accomplishment in my first year was advancing contraceptive access in the clinic,” she says. When Dr. Ragunanthan got to the DHC, they did not offer LARC (long-acting, reversible contraception) devices in the clinic. For example: if someone wanted an IUD or a Nexplanon arm implant, that device would have to be ordered for them. “And in that waiting time, someone could get pregnant,”she explains. “We’re in a place with one of the highest teen pregnancy rates in the country and giving a teenager or young woman access to a LARC can really change the trajectory of her life.”

In addition to Dr. Ragunanthan’s efforts on enhancing care for high-risk obstetrics and improving contraception access in the DHC, she aims to expand her reach beyond the clinic. Dr. Ragunanthan recently conducted a ‘Lunch and Learn’ session for nurse practitioners in the community to teach attendees about contraception. She also persuaded two pharmacies to stock the emergency contraception pill Ella (ulipristal acetate) in their stores, which was previously unavailable in the region.

While Dr. Ragunanthan focuses her efforts on her local community, there are disparities to address all over the country and the globe. For others wishing to work on these issues, Dr. Ragunanthan encourages pacing yourself, as addressing the needs of high-risk patients requires a multifaceted approach.

“What feels like an insurmountable problem or set of problems, it is best to just take things one small step at a time,” Dr. Ragunanthan says. “If you or someone you know feels a calling to do that, then I really encourage you to go for it. We create the change we want to see in the world.”

In their third year of residency, UPMC Magee-Womens Hospital residents can do an elective rotation with Dr. Ragunanthan at the Delta Health Center. This rotation provides residents with valuable experience working in a rural setting with desperate need using limited resources. To learn more, residents may reach out to Dr. Ragunanthan directly at nina.w.ragu@gmail.com.