Patience Afulani, PhD, MD, MPH

Associate Professor
Epidemiology & Biostatistics

My research focuses on the social and health system factors underlying disparities in reproductive, maternal, neonatal, and child health (RMNCH). I am particularly interested in how RMNCH outcomes are shaped by quality of care in health facilities as well as by social determinants. I also seek to contribute to improved measurement of quality of care, particularly person-centered care, and to the development of evidence-based interventions to improve RMNCH outcomes and reduce disparities.

My current projects include developing an intervention to improve person-centered maternity care (PCMC) in Kenya with a focus on provider stress and unconscious bias; examining drivers of poor PCMC in Ghana; adaptation of the PCMC scale for women of color in California; and examining healthcare workers' perceived preparedness for COVID-19 and associated factors in Ghana and Kenya.

My PhD dissertation examined sources of disparities in quality of antenatal care and how this affects use of skilled birth attendants and birth outcomes in sub-Saharan Africa. My post-doctoral work focused on measurement of person-centered maternity care; research into sources of disparities in PCMC and barriers to providing PCMC; and design and evaluation of interventions to improve quality of care including PCMC — in Kenya, Ghana, and India. I have also conducted research on the health and reproductive behavior of migrants from Africa, and on the consequences of food insecurity in the United States.

I obtained my Bachelor of Medicine and Surgery (MBChB) from the University of Ghana Medical School, and an MPH with a certificate in Global Health and a PhD in Public Health from the University of California, Los Angeles. I also completed a post-doctoral fellowship with the Preterm Birth Initiative at UCSF.


Understanding how COVID-19 affected black pregnant women early in the pandemic: A cross-sectional survey.


Bell AJ, Afulani P, Compton S, Barringer S, Kaselitz E, Muzik M, Moyer CA

Caring for providers to improve patient experience (CPIPE): intervention development process.

Global health action

Afulani PA, Oboke EN, Ogolla BA, Getahun M, Kinyua J, Oluoch I, Odour J, Ongeri L

Mixed methods evaluation of the Caring for Providers to Improve Patient Experience intervention.

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

Afulani PA, Getahun M, Okiring J, Ogolla BA, Oboke EN, Kinyua J, Oluoch I, Odiase O, Ochiel D, Mendes WB, Ongeri L

Psychometric assessment of the US person-centered prenatal and maternity care scales in a low-income predominantly Latinx population in California.

BMC women's health

Afulani PA, Coleman-Phox K, Leon-Martinez D, Fung KZ, Martinez E, Garza MA, McCulloch CE, Kuppermann M

A scoping review, mapping, and prioritisation process for emergency obstetric and neonatal quality of care indicators: Focus on provision and experience of care.

Journal of global health

Wang D, Sacks E, Odiase OJ, Kapula N, Sarakki A, Munson E, Afulani PA, Requejo J, Revisioning Emergency Obstetric and Newborn Care (EmONC) quality of care workstream

Food Insecurity and Mental Distress Among WIC-Eligible Women in the United States: A Cross-Sectional Study.

Journal of the Academy of Nutrition and Dietetics

Herman DR, Westfall M, Bashir M, Afulani P

Cross-cultural adaptation and psychometric properties of the Chinese version of the Person-Centered Maternity Care Scale.

BMC pregnancy and childbirth

Zhong X, Hu R, Afulani PA, Li X, Guo X, He T, Li D, Li Z

Validation of the person-centered maternity care scale at governmental health facilities in Cambodia.

PloS one

Naito YT, Fukuzawa R, Ganchimeg T, Afulani PA, Aiga H, Kim R, Katsumata AT

Person-centred sexual and reproductive health: A call for standardized measurement.

Health expectations : an international journal of public participation in health care and health policy

Afulani PA, Nakphong MK, Sudhinaraset M

Provider implicit and explicit bias in person-centered maternity care: a cross-sectional study with maternity providers in Northern Ghana.

BMC health services research

Afulani PA, Okiring J, Aborigo RA, Nutor JJ, Kuwolamo I, Dorzie JBK, Semko S, Okonofua JA, Mendes WB

The Case for Using a Behavior Change Model to Design Interventions to Promote Respectful Maternal Care.

Global health, science and practice

Diamond-Smith N, Walker D, Afulani PA, Donnay F, Lin SPY, Peca E, Stanton ME

Sources of stress and coping mechanisms: Experiences of maternal health care providers in Western Kenya.

PLOS global public health

Getahun M, Oboke EN, Ogolla BA, Kinyua J, Ongeri L, Sterling M, Oluoch I, Lyndon A, Afulani PA

Context Matters: Factors Affecting Implementation of Simulation Training in Nursing and Midwifery Schools in North America, Africa and Asia.

Clinical simulation in nursing

Baayd J, Heins Z, Walker D, Afulani P, Sterling M, Sanders JN, Cohen S

Associations between self-reported obstetric complications and experience of care: a secondary analysis of survey data from Ghana, Kenya, and India.

Reproductive health

Kapula N, Sacks E, Wang DT, Odiase O, Requejo J, Afulani PA, Revisioning EmONC Quality of Care Workgroup

Individual and situational predictors of psychological and physiological stress and burnout among maternity providers in Northern Ghana.

PloS one

Nutor JJ, Aborigo RA, Okiring J, Kuwolamo I, Dorzie JBK, Getahun M, Mendes WB, Afulani PA

Training nurse simulation educators at scale to improve maternal and newborn health: a case study from Bihar, India.

BMC medical education

Madriz S, Afulani P, Spindler H, Ghosh R, Subramaniam N, Mahapatra T, Das A, Sonthalia S, Gore A, Cohen SR, Handu S, Walker D

IMAgiNE EURO: Data for action on quality of maternal and newborn care in 20 European countries during the COVID-19 pandemic.

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

Benová L, Lawn JE, Graham W, Chapin EM, Afulani PA, Downe S, Hailegebriel TD, Lincetto O, Sacks E

Pregnancy-related COVID worry, depressive symptom severity, and mediation through sleep disturbance in a low-income, primarily Latinx population in California's Central valley.

Journal of psychiatric research

Felder JN, Afulani PA, Coleman-Phox K, Omowale SS, McCulloch CE, Lessard L, Kuppermann M

Strategies to reduce stigma and discrimination in sexual and reproductive healthcare settings: A mixed-methods systematic review.

PLOS global public health

Bohren MA, Vazquez Corona M, Odiase OJ, Wilson AN, Sudhinaraset M, Diamond-Smith N, Berryman J, Tunçalp Ö, Afulani PA

Impact of hair type, hair sample weight, external hair exposures, and race on cumulative hair cortisol.


Moody SN, van Dammen L, Wang W, Greder KA, Neiderhiser JM, Afulani PA, Willette A, Shirtcliff EA

Adaptation of the Person-Centered Maternity Care Scale in the United States: Prioritizing the Experiences of Black Women and Birthing People.

Women's health issues : official publication of the Jacobs Institute of Women's Health

Afulani PA, Altman MR, Castillo E, Bernal N, Jones L, Camara T, Carrasco Z, Williams S, Sudhinaraset M, Kuppermann M

Self-reported provision of person-centred maternity care among providers in Kenya and Ghana: scale validation and examination of associated factors.

BMJ global health

Afulani PA, Aborigo RA, Nutor JJ, Okiring J, Kuwolamo I, Ogolla BA, Oboke EN, Dorzie JBK, Odiase OJ, Steinauer J, Walker D

Job satisfaction among healthcare workers in Ghana and Kenya during the COVID-19 pandemic: Role of perceived preparedness, stress, and burnout.

PLOS global public health

Afulani PA, Nutor JJ, Agbadi P, Gyamerah AO, Musana J, Aborigo RA, Odiase O, Getahun M, Ongeri L, Malechi H, Madadi MO, Arhinful B, Kelly AM, Awoonor-Williams JK

Examining person-centered maternity care in a peri-urban setting in Embakasi, Nairobi, Kenya.

PloS one

Oluoch-Aridi J, Afulani P, Makanga C, Guzman D, Miller-Graff L

Community Perceptions of Person-Centered Maternity Care in Migori County, Kenya.

Frontiers in global women's health

Odiase O, Akinyi B, Kinyua J, Afulani P

Provider perceptions of lack of supportive care during childbirth: A mixed methods study in Kenya.

Health care for women international

Buback L, Kinyua J, Akinyi B, Walker D, Afulani PA

Understanding disparities in person-centred maternity care: the potential role of provider implicit and explicit bias.

Health policy and planning

Afulani PA, Ogolla BA, Oboke EN, Ongeri L, Weiss SJ, Lyndon A, Mendes WB

Development of the person-centered prenatal care scale for people of color.

American journal of obstetrics and gynecology

Afulani PA, Altman MR, Castillo E, Bernal N, Jones L, Camara TL, Carrasco Z, Williams S, Sudhinaraset M, Kuppermann M

Exploring women's childbirth experiences and perceptions of delivery care in peri-urban settings in Nairobi, Kenya.

Reproductive health

Oluoch-Aridi J, Afulani PA, Guzman DB, Makanga C, Miller-Graff L

Inadequate preparedness for response to COVID-19 is associated with stress and burnout among healthcare workers in Ghana.

PloS one

Afulani PA, Gyamerah AO, Nutor JJ, Laar A, Aborigo RA, Malechi H, Sterling M, Awoonor-Williams JK

Person-centered antenatal care and associated factors in Rwanda: a secondary analysis of program data.

BMC pregnancy and childbirth

Miller P, Afulani PA, Musange S, Sayingoza F, Walker D

Person-centered maternity care and postnatal health: associations with maternal and newborn health outcomes.

AJOG global reports

Sudhinaraset M, Landrian A, Golub GM, Cotter SY, Afulani PA

The Relationship Between Counseling and Adherence to Antiretroviral Therapy Among Pregnant and Breastfeeding Women Enrolled in Option B.

AIDS education and prevention : official publication of the International Society for AIDS Education

Nutor JJ, Slaughter-Acey JC, Afulani PA, Obimbo MM, Mojola SA

Development and validation of a person-centered abortion scale: the experiences of care in private facilities in Kenya.

BMC women's health

Sudhinaraset M, Landrian A, Afulani PA, Phillips B, Diamond-Smith N, Cotter S

Perceived preparedness to respond to the COVID-19 pandemic: a study with healthcare workers in Ghana

J Glob Health Sci

Patience A. Afulani, Akua O. Gyamerah, Raymond A. Aborigo, Jerry John Nutor, Hawa Malechi, Amos Laar, Mona Sterling, and John Koku Awoonor-Williams8

Providers' perceptions of communication and women's autonomy during childbirth: a mixed methods study in Kenya.

Reproductive health

Afulani PA, Buback L, Kelly AM, Kirumbi L, Cohen CR, Lyndon A

Providers' perceptions of disrespect and abuse during childbirth: a mixed-methods study in Kenya.

Health policy and planning

Afulani PA, Kelly AM, Buback L, Asunka J, Kirumbi L, Lyndon A

A Rapid Review of Available Evidence to Inform Indicators for Routine Monitoring and Evaluation of Respectful Maternity Care.

Global health, science and practice

Afulani PA, Buback L, McNally B, Mbuyita S, Mwanyika-Sando M, Peca E

Association between person-centered maternity care and newborn complications in Kenya.

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

Sudhinaraset M, Landrian A, Afulani PA, Diamond-Smith N, Golub G

Accountability for respectful maternity care.

Lancet (London, England)

Afulani PA, Moyer CA

Quality of antenatal care and associated factors in a rural county in Kenya: an assessment of service provision and experience dimensions.

BMC health services research

Afulani PA, Buback L, Essandoh F, Kinyua J, Kirumbi L, Cohen CR

Providers and women's perspectives on person-centered maternity care: a mixed methods study in Kenya.

International journal for equity in health

Sudhinaraset M, Giessler K, Golub G, Afulani P

Toward the development of a short multi-country person-centered maternity care scale.

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics

Afulani PA, Feeser K, Sudhinaraset M, Aborigo R, Montagu D, Chakraborty N

Measuring what matters for maternal and newborn health.

The Lancet. Global health

Diamond-Smith N, Afulani P

Can integrated clinical simulation trainings improve person-centred maternity care? Results from a pilot project in Ghana.

The Lancet Global Health

P Afulani, R Aborigo, S Cohen, C Moyer, D Walker, J Williams

Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana.

Birth (Berkeley, Calif.)

Afulani PA, Aborigo RA, Walker D, Moyer CA, Cohen S, Williams J

Food insecurity, mental health, and use of mental health services among nonelderly adults in the United States.

Journal of Hunger & Environmental Nutrition

Patience A. Afulani, Alisha Coleman-Jensen, Dena Herman

Politics and Public Service Provision in Africa’s New Democracies.

International Journal of Politics, Culture, and Society

Joseph Asunka, Patience A. Afulani

Validation of the person-centered maternity care scale in India.

Reproductive health

Afulani PA, Diamond-Smith N, Phillips B, Singhal S, Sudhinaraset M

Development of a Person-Centered Family Planning Scale in India and Kenya.

Studies in family planning

Sudhinaraset M, Afulani PA, Diamond-Smith N, Golub G, Srivastava A

Conceptualizing pathways linking women's empowerment and prematurity in developing countries.

BMC pregnancy and childbirth

Afulani PA, Altman M, Musana J, Sudhinaraset M

Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity.

Gates open research

Sudhinaraset M, Afulani P, Diamond-Smith N, Bhattacharyya S, Donnay F, Montagu D

Transnational ties and the health of sub-Saharan African migrants: The moderating role of gender and family separation.

Social science & medicine (1982)

Afulani PA, Torres JM, Sudhinaraset M, Asunka J

Food Insecurity and Cost-Related Medication Underuse Among Nonelderly Adults in a Nationally Representative Sample.

American journal of public health

Herman D, Afulani P, Coleman-Jensen A, Harrison GG

Improve Antenatal Care in Ghana’s Lower-Level Health Facilities

Improve Antenatal Care in Ghana’s Lower-Level Health Facilities

Afulani PA

Determinants of maternal health and health-seeking behavior in sub-Saharan Africa: The role of quality of care

Determinants of maternal health and health-seeking behavior in sub-Saharan Africa: The role of quality of care

Afulani PA

Food Insecurity and Health Outcomes Among Older Adults: The Role of Cost-Related Medication Underuse.

Journal of nutrition in gerontology and geriatrics

Afulani P, Herman D, Coleman-Jensen A, Harrison GG

Delaying and reducing medication use as a coping mechanism for food insecurity (268.6).

The FASEB Journal

Dena Herman, Patience Afulani, Gail Harrison, Alisha Coleman-Jensen

Using community health workers in community-based growth promotion: what stakeholders think.

Health education research

Afulani PA, Awoonor-Williams JK, Opoku EC, Asunka J