#463 - 🗳️ Meet the Neonatologist Running for AAP President - A Conversation with Dr. Wanda Barfield
Disclosure: Dr. Wanda Barfield appeared on this episode in her personal capacity. The views she expresses are her own and do not represent the official positions of the Centers for Disease Control and Prevention, the Department of Health and Human Services, or the United States government.
Hello friends 👋
The American Academy of Pediatrics has never had a neonatologist as president. This September, that could change. In this special episode, Ben sits down with Dr. Wanda Barfield, neonatologist, retired Rear Admiral and Assistant Surgeon General in the US Public Health Service, and longtime director of the CDC's Division of Reproductive Health, to hear what she would bring to the role. She lays out her three priorities, supporting pediatricians, protecting access, and leading with science and equity, and addresses the questions our field is wrestling with right now: training, staffing, the erosion of trust in science, and whether neonatology should go it alone. Her answer is that we are stronger together, and that having a neonatologist at the helm of the AAP would give our specialty a voice it has never had. Voting is open to AAP members through September 16. Meet the candidate, then go vote.
----
Short Bio: Dr. Wanda Barfield is a neonatologist, public health leader, and retired Rear Admiral and Assistant Surgeon General in the U.S. Public Health Service. She has served for the past 14 years as director of the CDC's Division of Reproductive Health, within the National Center for Chronic Disease Prevention and Health Promotion.She earned both her M.D. and M.P.H. at Harvard, completed pediatrics residency at Walter Reed Army Medical Center, and did her neonatal-perinatal fellowship through Harvard's Joint Program in Neonatology. That fellowship spanned Boston Children's, Brigham and Women's, and Beth Israel. Before the CDC she was an Army medical officer, pediatrician, and neonatologist, including four years as a neonatologist and Army Major at Madigan Army Medical Center in Tacoma. She joined the CDC in 2000 through the Epidemic Intelligence Service and became division director in 2010. She still takes clinical service. She is an attending neonatologist at Grady Memorial, a professor of pediatrics at the Uniformed Services University of the Health Sciences, an assistant professor at Emory School of Medicine, and an adjunct professor and health policy scholar at Emory's Rollins School of Public Health.
She is running against Lois K. Lee, a pediatric emergency medicine physician at Boston Children's. Voting runs September 2 to 16, and the winner serves as AAP president in 2028, succeeding Terri McFadden. Worth mentioning to your audience: DeWayne Pursley, chief of neonatology at Beth Israel Deaconess, is on the same ballot for an at-large board seat, so neonatology is unusually well represented this cycle.
----
Ready to vote?
Voting for AAP president-elect is open to AAP members through September 16, 2026. You will need to log in with your AAP membership, so make sure your membership has not lapsed.
----
The transcript of today's episode can be found below 👇
Ben Courchia, MD (00:00.824)
Hello, everybody. Welcome back to the Incubator Podcast. We're back today for a special conversation. We have the pleasure of having with us in the studio today Dr. Wanda Barfield. Dr. Barfield, welcome to the podcast.
Wanda D. Barfield, MD (00:13.858)
Thank you so much, Ben, for this opportunity to be here.
Ben Courchia, MD (00:16.962)
Yeah, we're very excited to have you. I'm going to talk a little bit about who you are, but I think I'll open your bio by saying that you are running for the presidency of the American Academy of Pediatrics (AAP), and that's what we're hoping to chat with you about today. You are a neonatologist, a retired rear admiral and assistant surgeon general in the United States Public Health Service. You earned your medical diploma from Harvard Medical School and your MPH (Master of Public Health) at Harvard Chan School. You trained in pediatrics at Walter Reed, and did your neonatal-perinatal fellowship through Harvard's joint program. Before your federal work, you served as an Army physician and neonatologist, including four years at Madigan Army Medical Center. You joined the CDC (Centers for Disease Control and Prevention) in 2000 through the Epidemic Intelligence Service, and in 2010 you became the director of the division of reproductive health, a role you have now held for 14 years. You're a professor of pediatrics at the Uniformed Services University, you teach at Emory in both the medical school and the Rollins School of Public Health in Atlanta, and you still take clinical service as an attending neonatologist at Grady. You've published over 200 papers, you're a member-elect of the National Academy of Medicine. You served as the CDC liaison for the AAP Section on Neonatal-Perinatal Medicine and to the Committee on Fetus and Newborn. You were an author of AAP guidance covering NICU (Neonatal Intensive Care Unit) disaster preparedness, opioid withdrawal, and neonatal levels of care. And now you're running for the presidency of the American Academy of Pediatrics, with voting starting in September — the election runs between September 2nd and September 16th, so definitely mark those dates in your calendar.
You've said that a statistic that changed your career was learning early on that Black infants in this country die at twice the rate of white infants, and thirty-some years later you're running for the presidency of the AAP at a moment, in my opinion, when trust in science itself is under duress, under strain. How do you connect these two events, these two things?
Wanda D. Barfield, MD (02:39.98)
Yes, so when I first thought about life in college, I really wanted to be a veterinarian. I was the kid who was taking in all sorts of stray animals — thankfully my mother was incredibly patient — we had dogs, cats, squirrels. I had a pet squirrel named Rocky, actually. I thought I was going to go to vet school. But then, when I started college, I noted a statistic that shocked me: that Black babies died at a rate twice that of white babies. I knew I wanted to take care of infants, and I decided that's what I wanted to do pretty early on — although I explored other areas, it was the one that stuck with me.
The other thing was, I had an opportunity to volunteer as a junior in college, and they said, "Where would you like to volunteer, the emergency room or the NICU?" At the time I said, "What's a NICU?" I had this chance to be in this amazing place — at that time NICUs were much more centrally based, with open bays — and you had a chance, even as a volunteer, holding babies, feeding babies, stocking supplies. I could still see ultrasounds, procedures, evaluations occurring in the NICU, and it was fascinating to see all that science and physiology, then go back to my classes and see the connection. So that's the reason I love neonatology and neonatal medicine.
We've seen incredible improvements in neonatal survival, specifically gestational-age-specific survival — we're caring for infants at 22, 23 weeks' gestation, an incredible improvement over the decades. But unfortunately disparities still persist, and we know these disparities are not genetic. They relate to the environment in which people live, and particularly the environments in which women and girls live, grow, and learn long before pregnancy. These social drivers of health impact the outcomes of the babies we care for. And that's also why, for me as a neonatologist, I knew I needed to focus not only on direct neonatal care, which is so important, but also on the systems of care and ways to improve those systems. That's why I've also focused on perinatal quality improvement that includes both moms and babies, so we could address improving infant health outcomes, but also improving maternal health and eliminating another huge disparity: pregnancy-related deaths.
Ben Courchia, MD (06:05.43)
That's fascinating, and I'll come back to that inception story about statistics. But first I'd like to put myself in the shoes of one of our listeners who may be wondering, at a time where neonatology is having a bit of an identity crisis in terms of training and staffing, what will be some of your priorities, assuming you win this election and become president of the AAP? What will be your first priorities to address during what is a short tenure — the AAP doesn't give its presidents very long tenures. What would your priority be, specifically, given that you're a neonatologist yourself and know the struggle we're going through right now?
Wanda D. Barfield, MD (06:49.856)
I will say the areas I'm really focusing on are, first, supporting pediatricians — that's all pediatricians: neonatologists, pediatric subspecialists, general pediatricians, those who serve the community in terms of improving child health. The second is really protecting access. We have similarities across the board in terms of access — we know Medicaid and CHIP (Children's Health Insurance Program) are major contributors to the health of newborns, that it's important for pregnancy, for child health, and for infants who are premature and survive. Many have a complex course requiring referrals, subspecialty care, special assistance and support, and a lot of that is undergirded by Medicaid, so we need to make sure we continue to have that as a robust system and ensure access for children.
The third area is leading with science and equity. I've spent many years working with data, and showing how powerful evidence-based data can be in moving things forward. On the perinatal side, here's another interesting issue around data: if you're a neonatologist, you know the general statistics about infant mortality — neonatal mortality, early neonatal mortality, late neonatal mortality, post-neonatal mortality — and that those different time periods carry different risks of death. In the early neonatal period, early gestation is a major risk factor; later in the neonatal period and through infancy, the risk of SIDS (Sudden Infant Death Syndrome), for example, is high.
One of the things we started to look at with maternal mortality data was, when in time is a mother at risk for certain conditions? And believe it or not, that was sort of groundbreaking — what we found was that more than 50% of pregnancy-related deaths actually occurred later in the postpartum period, not at delivery, not a few days after, but later. As a result, women were at risk for certain conditions that weren't being attended to once they got home — "I'm exhausted, I'm tired." "Well sweetie, you just had a baby." But it wasn't about that — it was about things like poor heart function and cardiomyopathy. In my state of Georgia, that's a leading cause of pregnancy-related death. So the data is really important, and there's an opportunity to use that data to think about how we address issues of equity.
I'd also like us to think about how data can be powerful in informing our quality improvement practices, how we can think about specific interventions, and how that data can be translated to action. One example is risk-appropriate care. When I served on the Committee on Fetus and Newborn, there was a lot of interest in revising neonatal levels of care in 2004, because it lacked specific evidence on survival by level. I mentored an amazing MPH student, and we looked at 30 years of evidence on the risk of death for very-low-birth-weight and very preterm infants, and found there was an increased odds — a 60% increased odds of death — for very-low-birth-weight and very preterm infants born outside of a level 3 or higher facility. That was an opportunity to then inform the policy statement on levels of neonatal care in 2012. There were also opportunities to look at the data at the state level, and work with state health officials, many of whom were pediatricians, to think about ways to improve levels of care based on the geographic distribution of states — because states can inform and help hospitals in terms of their levels of care.
Data is really incredibly powerful in helping us reduce disparities. Many of you may know the late Dr. Allison Rose, an incredible neonatologist and assistant professor at Emory — she passed, unfortunately, far too soon. One of the incredible things she did was look across the state at utilization and access to human donor milk, and found huge disparities by economic areas of the state — that many hospitals serving low-income families, such as Grady Hospital, were less likely to provide human donor milk to their babies compared to hospitals with more resources. She used the data to show these huge disparities in donor milk access, despite the fact that many of the babies in hospitals not receiving donor milk were incredibly premature and ill, and needed that resource to avoid the risk of necrotizing enterocolitis (NEC). Her work helped convince the state, with the help of the Georgia AAP chapter, to support Medicaid funding for access to human donor milk for all at-risk infants, regardless of what part of the state they lived in or the local economics. Those are the kinds of important actions we can take as neonatologists to improve clinical care — using data to inform and improve outcomes, as well as advocate for better care, is really important.
Ben Courchia, MD (14:23.544)
That's very interesting, because what you're describing is really restoring the continuum of care in what has been pretty segmented over the years — high-risk pregnancy, maternal-fetal medicine, neonatology, and then pediatrics — and trying to see patients along this continuum rather than in individual buckets.
Wanda D. Barfield, MD (14:46.06)
Yes, creating a continuum. As pediatricians, I believe we think more developmentally and long-term about the opportunities we have to improve something early on, because it has longer-term benefits. We can continue to do that, and we can also work with our obstetrical colleagues — working with ACOG (American College of Obstetricians and Gynecologists) and SMFM (Society for Maternal-Fetal Medicine) has been something I've done for much of my career, they're wonderful partners. There's also the opportunity to work with the AMA (American Medical Association), and that's something AAP is doing now, which is critically important, because as neonatologists we see what may happen if consequences aren't attended to for our patients. Hopefully we can continue to think about ways we can work together so a child's life course is as optimal as possible.
Ben Courchia, MD (15:54.794)
I wanted to go back to a bit more of a program question when it comes to your tenure at the AAP, if you get to win the presidency. Neonatology right now is really facing a crisis when it comes to training enough neonatologists for the next generation, and we're wrestling with the concept of staffing. There are some core issues that have led to a lot of chatter about where neonatology should be. I'm wondering if you could address some of these, starting with training — what can we do to reform the training of young physicians so we can account for the stressors they're placed under, while still serving the needs of our specialty? Any thoughts on that?
Wanda D. Barfield, MD (16:53.9)
Yeah, we're challenged, especially now, with wonderfully bright individuals who, one, aren't necessarily going into medicine because of the challenge of debt, and then those who do go into medicine may not pick certain specialties within pediatrics because of the burden of debt.
Ben Courchia, MD (17:20.93)
Or pediatrics alone — general pediatrics alone.
Wanda D. Barfield, MD (17:24.512)
Or general pediatrics, right — they're not selecting pediatrics. We need to do a better job of showing that pediatrics is an important and rewarding specialty, but we also need to practically look at ways to reduce financial debt for our pediatric trainees.
Ben Courchia, MD (17:45.346)
What about staffing, Dr. Barfield? The AAP has done phenomenal work in the past year or two with the release of the staffing toolkit — a lot of units around the country are still trying to wrap their heads around what a modern staffing model looks like. Do you think the AAP is doing enough on that front currently? Could it do more, and if so, what would that look like?
Wanda D. Barfield, MD (18:10.68)
I think the work AAP is doing with the staffing toolkit, and looking at where our gaps are, is really important. Our additional challenges are that certain parts of the country are rural and may have real gaps in the workforce important for the care of infants and children, and we're going to need to think strategically about what other resources and tools we can use in underserved areas. We've seen maternity deserts, and we know that will have ongoing sequelae for infants and children throughout their course. So we really need to think a lot about that.
Ben Courchia, MD (18:58.7)
That's very true. Going back to something we touched on — misinformation and mistrust — we've covered on the podcast some pretty scary statistics, for example the increase in the rate of refusal for the birth dose of vitamin K, which is on the rise and continues to rise. That's not even addressing the issue with the hepatitis B vaccine dose after birth, and so on. It doesn't look like the current administration is going to help with that particular trust issue between the medical community and patients. I'm wondering — the AAP has been doing such a phenomenal job in these turbulent times — how do you plan on keeping that momentum going, and maybe infuse some of your background, including your military background, to help get us back on track with popular opinion, in terms of reestablishing that bond that used to exist between families and the Academy?
Wanda D. Barfield, MD (20:10.668)
Yes, it's really disheartening to see these changes in parents accepting or understanding the importance of preventive interventions, whether it's immunizations or, for example, vitamin K, and of course hepatitis B prevention is so critically important — many of us who've practiced medicine a bit longer have seen the consequences of that, and we don't want to see it again. I honestly think fostering and maintaining trust is one of the biggest threats to pediatrics and to pediatricians. It's important to note that we have a patient we care greatly about, but we also need to work with the people who care for them — their parents and families. It's really important that we continue to maintain that trust, because it's hard to regain once it's lost. We have a lot of history in this country around issues of trust and loss of trust, and we've seen it over time — but now it's becoming broader. We have groups of people who have been historically marginalized, disregarded, disrespected, and we need to think about ways — and I think AAP is doing this — to not only maintain trust but restore it. Part of that is making sure we're listening, and listening well, so we understand what's leading our parents to not quite understand some important, evidence-based issues around care.
So that's really important. This issue of trust is critically important — I've worked with Native American groups and tribes, and it's very important that we first listen and understand the context in which their health challenges evolved, before we try any interventions or ideas we may have. Listening is really important because it fosters trust and strengthens relationships. Part of what we need to do as pediatricians is continue to strengthen our relationships with families and parents, so they're able to trust us — because there's going to be a point where, if we're losing respect, we're not going to be able to provide evidence-based information. Families aren't going to hear our evidence if they don't feel our respect. We need to make sure we continue that journey. I know it isn't easy, but we can do it — I really believe pediatricians fundamentally have the tools and ability to maintain trust. One of the things AAP is doing now is working to dispel false information, make sure it's clear, and offer tools not only for families to understand the evidence that's there, but for pediatricians, so they have a great way of explaining information that's unfortunately become confusing.
Ben Courchia, MD (24:27.564)
It's interesting that you mention data — we talked about this in our first question. You're someone who, at an early age, was impressed by statistics, which I find is usually the opposite — I feel like the thing that strikes us first is usually a single story, a single patient. For you it was more of a statistic, and you were able to capture what that meant for an entire community. What do you think our approach should be as neonatologists and pediatricians, especially at a time when data is being used and twisted in so many ways to push a specific agenda? It feels like we're losing the battle when it comes to the validity of data — we believe, as scientists, that data stands on its own and tells the story, but we're seeing today that if twisted hard enough, data will tell whatever story somebody wants to push. What are your thoughts on that?
Wanda D. Barfield, MD (25:34.316)
Yeah, I've had some experience with this. Data is very important — I've worked with large population data, it's very powerful. But something that can be equally powerful is personal stories and lived experience. We need to think about ways to combine data and information with personal stories that resonate with individuals in a variety of circumstances.
I'll give you an example: the Hear Her Campaign. This was a campaign that told the stories of a variety of women and their experiences being challenged with a pregnancy-related complication. Some of this was inspired by a personal story — a colleague at CDC, a commissioned officer and PhD epidemiologist who had done incredible work addressing health disparities. A few weeks after delivering her daughter, she started to have health complications — she was exhausted, her feet were swollen, she had headaches — and she kept going to her provider and wasn't being listened to. After about the fifth visit, she collapsed and died. And so we provided stories that told of those who were listened to and sought care, and those who weren't listened to but avoided pregnancy-related complications and lived to tell their story. I think that made a big difference, in addition to the data, in showing why this issue is important — because data is important, but we also need people to understand an issue is so important that there's a public outcry, that they understand this is a dangerous, challenging thing, and something needs to be done. That's how, through partnerships and working with a variety of leaders in many different scenarios, we're able to advocate for change.
Ben Courchia, MD (28:31.49)
Now that we're running a bit short on time, I wanted to use the rest of it to talk about your background specifically. One of the things that stands out is your qualities as a leader, which I think stems from a stellar career in the military. In doing the background research for this episode, I found that your father, also a military man, had a very important influence on you. Can you tell us a bit about that mindset, and how it shaped who you are today?
Wanda D. Barfield, MD (29:12.014)
For me, part of my experience is that I've seen, in my father, my mother, and many other elders, their determination — their determination to overcome the challenges they faced in their time. My father was one of the few who was chief of the boat (COB), the head enlisted person on nuclear submarines. He had challenges — some people didn't believe he should be in that position — but he was calm and steadfast and had an amazing career. He also taught me a lot about patience and persistence. I think that's also helped drive me in this work of improving outcomes for kids — that there are opportunities that come up, and with the right combination of data, people, and partnership, we really can make a difference. That's why I'm so passionate about this area — I think it's critically important.
Ben Courchia, MD (30:30.094)
Do you think this could be a message for people who are wondering — and I won't exclude myself from this — whether it's time for neonatology to establish itself as an independent field of medicine? I feel like this is really what's at stake: are we going to be willing to be persistent and find solutions together? We were joking off-air that when the United Kingdom left the European Union, they called it Brexit, and now they're calling it "Bregret," because it's easy to leave, and then it brings a whole new set of challenges. For people wondering about this today in our field, is your answer going to stem from what you learned from your father — that we just need to be persistent, and we'll find a solution together?
Wanda D. Barfield, MD (31:29.078)
Yes, I really do believe we're better together as a field of pediatrics. It's also important to note that, especially in my experience managing and leading large organizations, there's real strength in collaborative work. One thing to think about is that if neonatologists break away, there are administrative and policy-related responsibilities that AAP is honestly doing a fantastic job on — all the things that sort of make the trains run within an organization. As a separate neonatology organization, that would be an entity unto itself.
The other thing to think about is what our voice would be as a separate organization from pediatrics — there would be some limits to what we could talk about, whereas now we have a broader reach. I'll give you an example: paid family leave. It's an important area with great opportunities for infant bonding, breastfeeding, mental health for families. There's been the opportunity to consider paid family leave for families of NICU patients, and the state of Colorado did that at the beginning of this year — that was actually the result of a policymaker in Colorado who had a 29-weeker. In addition to the other areas Colorado focused on for paid family leave for a variety of medical conditions, they also incorporated paid family leave for families with babies in the NICU — an additional 12 weeks. These are the kinds of things where, in a broader discussion with policymakers, there's more opportunity to think as a large body together, rather than thinking about those areas individually.
Another example is the AAP Leadership Forum, which was an amazing opportunity for pediatricians to propose important resolutions to the AAP that could be moved forward. There were several great proposals, a couple related to neonatology — one, in particular, was the opportunity to provide safe sleep education at the time of discharge from the NICU, modeling safe sleep and appropriate infant sleep positions prior to infants going home. That's something that's been backed with data and policy, and we know safe sleep will also have implications for longer-term infant outcomes. So wouldn't it be wonderful if, as we're thinking about these areas, it's not just a neonatologist issue, but a pediatrician's issue? I really think we have to be thoughtful about our power as a larger organization.
Ben Courchia, MD (35:34.37)
Yeah, I think that's a great message, and I think you're right that we can still accomplish a lot of great things together — and that persistence is what gets me excited about your candidacy and hopeful for the future. I wanted to get into the details of the election for the people listening who are saying, "I'm going to make sure I vote." As we mentioned earlier, the election runs from September 2, 2026 until September 16, 2026. Can you tell us a bit about who's allowed to vote, and how that's done?
Wanda D. Barfield, MD (36:17.058)
Yes, I think it's very important for people to vote. The AAP president has an incredibly important role, sharing the voices of children, and this is an incredible opportunity to make sure the voices of neonatologists are included in that role. We all, as neonatologists, can make an impact with our votes, and I would highly encourage people to vote in order to influence the next few years of the AAP.
I think it's important to log on and look at the AAP election page, and really look at that information to make a decision. On September 2nd, you'll get information about the election, and have the opportunity to log in and select your candidate. I also think there will probably be a couple of "ticklers" that happen just before the election, so people are aware of their opportunity to vote — and again, this is for AAP members.
Ben Courchia, MD (37:37.848)
Is that what you call them — ticklers?
Wanda D. Barfield, MD (37:39.416)
Ticklers, yes — like little nudges, "get ready." I think that's a real opportunity — as neonatologists, if we want to be heard, we need to be engaged.
Ben Courchia, MD (37:42.08)
Those little nudges. Absolutely. And people, basically, you have to be a member of the American Academy of Pediatrics — which, by the way, I've historically been very slow in renewing my own membership — but it's important to make sure your membership hasn't lapsed at the time of the election, so you can vote. You can definitely find out more information about Dr. Barfield and the other candidate you mentioned, Dr. Lois Lee, who are both running for what's called the president-elect position. As a reminder, the AAP has a particular way of looking at the presidency: whoever wins the election will be president-elect for a year, then become president, and then become the immediate past president — so you have a variety of influence across those three years, in those three different roles.
People can learn more at the National AAP Elections Center — there's not a catchy website to memorize, but if you Google that, the first link gets you there, and from there you can learn more about the different candidates and log in to cast your vote between September 2nd and September 16th.
Dr. Barfield, thank you very much for your time. Before we wrap up, is there any message you want to leave the audience with?
Wanda D. Barfield, MD (39:25.036)
Yes, what I'd like to focus on as AAP president is making sure we support pediatricians, protect access, and lead with science and equity. Those are critically important areas, and I think, again, we can do it together.
Ben Courchia, MD (39:44.202)
I absolutely agree. There's a lot more detail about your vision for pediatrics and our field that we didn't have time to cover in a 35-minute interview — safety for people delivering care is also something near and dear to your heart. Everybody can find out more about your program at the AAP website, and we recommend everybody go vote between September 2nd and September 16th. Dr. Barfield, thank you so much for taking the time to come to the podcast and share your vision with our audience — we wish you the best of luck in the upcoming election.
Wanda D. Barfield, MD (40:20.67)
Thank you so much. This has been wonderful. Thank you.
Comments