Blair Wylie, MD, MPH, is investigating the potential health hazards for expectant mothers of cooking with fires fueled by wood, hay and other biomass fuels.
Blair Wylie, MD, MPH, delivers high-risk babies in Boston and travels to Africa to improve the health of pregnant women and children.
Blair Wylie, MD, MPH, delivers high-risk babies in Boston and travels to Africa to improve the health of pregnant women and children.  These days, she is investigating the potential health impacts of cooking with biomass fuels.

Blair Wylie, MD, MPH, practices medicine in Boston where she helps women deliver babies at Massachusetts General Hospital. Through her research, she is also determined to improve the health of mothers-to-be who live in poverty-stricken communities around the world.

“Women become pregnant in all corners of the world,” says Dr. Wylie, herself a mother of two. “I don’t think that country borders need to define where I perform research.”

Her passion for helping women and children has led her to seek out opportunities in global health care, a top priority at Mass General. She has treated women in a rural hospital in Haiti and studied the impact of malaria during pregnancy in India.

Today, Dr. Wylie’s research is in Africa where she is studying the potential health hazards of cooking on fires fed by biomass fuels such as wood, hay or cow dung — a household task many pregnant women perform every day.

In developing countries, where women prepare their meals by stirring pots over fires fed by these biomass fuels, they breathe in smoke from the fires. That smoke contains some of the same health hazards thrown off by cigarettes, which are well-known to cause health problems during pregnancy. Dr. Wylie says women sit for hours cooking over fires, often with a small child in their arms.

The substances released by cooking with biomass fuels could result in babies being born at a low birth weight, a marker for future health issues.

The substances released by cooking with biomass fuels could result in babies being born at a low birth weight, a marker for future health issues. They also could place babies at risk for pneumonia, which can permanently damage growing lungs.

The World Health Organization estimates up to 3 ½ million deaths can be attributed to the use of cooking or heating with biomass fuels.

But tackling this potential problem is more complicated than it might seem. There is a lack of data supporting how much of a health risk cooking with biomass fuels poses as well as disagreement over which stoves are best and how to convince families to change cooking habits. Thus far, initiatives to provide families in developing countries with cleaner burning stoves have not significantly improved the health of pregnant women and children.

For Dr. Wylie, such challenges draw her to the issue of biomass fuels and cookstove pollution. “There are a lot of unanswered questions,” she says. “For me, that makes it an intriguing area to jump into for research.”

A Focus on Women and Children

Mass General reinforced its commitment to global health care in 2006 when it created the MGH Center for Global Health. The center builds upon the hospital’s long record of leadership in disaster response and humanitarian aid and was designed to coordinate and advance the hospital’s international activities in medical care, research and education. The center is joined in such work by other hospital departments, individual doctors, researchers, nurses and care providers.

Many of the center’s global efforts have focused on the health needs of women and children. MGH experts established a birthing center in Zambia and investigated the impact of HIV/AIDS on women in South Africa. One example of the center’s frequent collaboration with the MGH Vincent Department of Obstetrics and Gynecology is the work of Annekathryn Goodman, MD. Dr. Goodman has established a cervical cancer screening program in the slums of Bangladesh and set up monthly Internet teaching sessions to give Ugandan providers an opportunity to review patient cases with Mass General’s OB/GYN staff.

“Women and children are the cornerstone of every community,” says David Bangsberg, MD, MPH, the center’s director. “Investing in women and children’s health strengthens families today and into the future.”

Isaac Schiff, MD, the Vincent’s chief, agrees. He says healthcare advances have reduced maternal deaths in the United States and other wealthy countries, but the rate remains far too high in low-resource nations. “As professionals who are committed to women’s health, we can’t just sit by while, worldwide, close to a half a million women die in childbirth,” Dr. Schiff says.

His department and the MGH Center for Global Health have developed a special relationship with Mbarara Hospital in rural southwest Uganda. Affiliated with Mbarara University of Science and Technology, the hospital reflects many of the medical challenges that exist elsewhere in Africa. MGH and Mbarara University are conducting research and training local healthcare providers with the goal of improving care across a wide range of health specialties.

A BioLite stove charging a cell phone as it burns.  Researchers are investigating whether such features on clean-burning stoves will persuade some families to abandon cooking with biomass fuels.
A BioLite stove charging a cell phone as it burns. Researchers are investigating whether such features on clean-burning stoves will persuade some families to abandon cooking with biomass fuels.

Critical Operations Delayed

In the spring of 2013, Dr. Wylie visited the hospital’s maternity ward. She discovered even though the facility is the largest referral hospital in southern Uganda, women had to walk into town to buy their own supplies for emergency C-sections — delaying by hours an operation that is critical for the safety of mother and baby.

Some nights on the maternity floor, she observed 60 patients for every midwife. She learned that during many deliveries, the woman makes the final push on her own, with no health professional to help her or the arriving child. On average, a woman dies about every 10 days.

After spending two days listening to the morning report of maternity cases at Mbarara Hospital, Dr. Wylie counted nine stillbirths and two additional neonatal deaths. The resident reading the report did not pause, nor did the faculty ask for more information.

The difference in outcomes between Mass General and Mbarara Hospital was unsettling, even for an obstetrician who specializes in treating women with high-risk pregnancies and challenging medical conditions.

Moms Helping Moms

Biomass fuels emit some of the same harmful pollutants found in cigarette smoke, including carbon monoxide, particulate matter and polycyclic aromatic hydrocarbons.

After returning to Boston, Dr. Wylie joined with another Mass General obstetrician, Laura Riley, MD, to launch a fundraising initiative, Moms Helping Moms. Through it, Boston families can make donations to buy supplies for the Mbarara maternity ward. The goal is to make deliveries safer and more comfortable for women and their newborns.

Dr. Wylie was introduced to global health early in her career. When she was a fourth-year medical student, through a connection of a family friend, she traveled to a village in rural Haiti to work for a month in a mission hospital. When she returned, she was determined to continue her work in global health care. During her residency and fellowship, Dr. Wylie used vacation days for international work.

Her interest in household air pollution and biomass fuels began during her fellowship in maternal fetal medicine at Columbia University. A professor’s lecture about problems related to cooking over smoky, poorly vented fires inspired her. As she listened to the lecture, she remembered the intense smell of burning in India where she had been studying malaria and pregnancy. Struck by the understanding that smoke from cooking fires probably affected more women and children around the world than malaria, Dr. Wylie joined the professor’s research group.

Biomass fuels emit some of the same harmful pollutants found in cigarette smoke, including carbon monoxide, particulate matter and polycyclic aromatic hydrocarbons.

The issue caught the attention of Hillary Clinton when she was secretary of state. Ms. Clinton helped launch the Global Alliance for Clean Cookstoves in 2010. The public-private initiative aims to introduce 100 million more efficient cooking devices into homes within a decade. Actress Julia Roberts and model Gisele Bündchen appeared in YouTube videos expressing their support. The initiative helped generate funding for new research into biomass fuels like Dr. Wylie’s.

Blair Wylie, MD, MPH, with Erik Clinton, MD, (left) who runs a program at to deliver unused medical supplies to places that need them most. Recently, Dr. Wylie co-founded a program to encourage donations to buy supplies for Mbarara Hospital’s maternity ward.
Blair Wylie, MD, MPH, with Erik Clinton, MD, (left) who runs a program at Mass General to deliver unused medical supplies to places that need them most. Recently, Dr. Wylie co-founded a program to encourage donations to buy supplies for Mbarara Hospital’s maternity ward.

The Pursuit of Specific Numbers

Many believe that cooking stoves do adversely affect health, but some researchers, like Dr. Wylie, would like science to lay out a better case. For previous studies on the biomass fuels issue, researchers had asked women to recall the birth weight of their children and hadn’t taken measurements. They asked women what type of cooking fuel they used, instead of monitoring exposure to pollutants.

Dr. Wylie wants to see specific numbers, so the biomass fuels studies she is involved with are different.

The Mass General researcher is leading one effort in Tanzania. Funded by the National Institutes of Health, the study is linked to a broader clinical trial following 240 women throughout pregnancy. The connection gives Dr. Wylie’s team access to birth weight measurements and data gathered from women’s placentas, the life-giving organ that connects fetus to mother during pregnancy. This study is unique because participants will wear a monitoring device to track exposure to carbon monoxide and fine particulate matter for 72 hours during their pregnancy. Dr. Wylie says that within a year, the team should have data on the effect of cookstove pollutant exposure on mother and fetus.

Biomass Fuels and the Cell Phone Incentive

The second study related to biomass fuels is in Ghana, where Dr. Wylie is collaborating with researchers from the Columbia University School of Public Health and Ghana’s Kintampo Health Research Center. The team will analyze data from more than 1,000 pregnant women who they have divided into three groups. Each group will use either a traditional three-stone fire, a stove that operates on liquefied petroleum gas (LPG) or a high-efficiency wood-burning stove made by the company BioLite.

The study is also structured to separate the impact of cooking with biomass fuels from the known effects of other factors of poverty, such as nutrition and access to prenatal care.

Primarily, the researchers will use a child’s birth weight and the occurrence of pneumonia during the first year of life to measure and compare adverse health effects. The study is also structured to separate the impact of cooking with biomass fuels from the known effects of other factors of poverty, such as nutrition and access to prenatal care.

The Ghana study might shed light on how to boost acceptance of more efficient stoves because the BioLite stove will charge a cell phone as it burns. In rural areas, where people must pay to recharge phones at commercial stations and there are no landlines, this could provide incentive to use the new stove. “If that stove could be used to make money, it might change the economics,” Dr. Wylie says.

Dr. Wylie is excited about the growing interest in global health care. She mentors young doctors in Boston who aspire to such work. “The world is only getting smaller,” she says.

To learn more about how you can support the global health research and patient care efforts at Mass General, contact us.