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Title V Technical Assistance Meeting

 Centering Community-Developed, Community-Led Social Change in Your Journey for Perinatal Health Equity

Jessica Huey, MPH, MSW, IBCLC, CD(DONA)
Program Manager, Infant Health
The Association of Maternal & Child Health Programs

As more and more maternal and child health (MCH) professionals strive to advance equity in perinatal health through programmatic and social change, it's fair to wonder what core values are necessary to support those efforts. We got some answers in a packed room at the AMCHP Annual Conference, when Aza Nedhari and Erin Snowden of Mamatoto Village in Washington, D.C., presented its perinatal health worker model.

In the session, "Perinatal Health Workers: An Innovative Approach to Maternal Health Service in Communities of Color," Nedhari and Snowden focused on the role their perinatal health workers (PHWs) play in providing wrap-around services to Medicaid-eligible black women to reduce disparities in infant and maternal health outcomes disproportionately experienced by black women in Washington. (View the recording.) Among the values Nedhari emphasized: "not replicating models that perpetuate poverty."

The perpetuation of poverty persists in programs that employ community health workers (CHWs) to work with socially and economically disadvantaged communities but that do not pay the CHWs the equivalent of a living wage. The success of programs involving CHWs speaks to a truth that has always been known within communities but that is only recently beginning to be recognized at a larger systems level: Under-resourced communities and the people in those communities know what they need to heal and thrive.

By embracing that people with lived experiences are best qualified to design programs to support community health needs, our work in MCH is re-centered: Our role becomes supporting the community leaders creating and implementing these programs on the ground. This includes recognizing their skills, talent, training, and challenges by providing appropriate compensation, and not continuing cycles of poverty and discrimination affecting the communities that these service practitioners work in and, by definition, are from.

This theme arose again in a #MaternalJustice Twitter chat hosted after the conference by MomsRising, in response to the question, "How can we best support doulas to support pregnant women?" Doulas are one element of the larger health care system that can lead to improved perinatal health outcomes, especially among communities experiencing health inequities. While doulas typically provide informational, physical, and emotional support to birthing people, community doula models expand beyond those roles to include more prenatal and postpartum support, attending some medical appointments, and connecting birthing people to social resources extending beyond those specific to perinatal health. Community doulas may help to mitigate some of the effects of living in an under-resourced community where historical discrimination and oppression restrict access to information and services.

As several states move to expand access to doula services through Medicaid reimbursement, it is necessary to focus on equitable reimbursement for doulas. The Bay State Birth Coalition, a consumer-led organization that is seeking certified professional midwife licensure in Massachusetts, asked during the chat that states "Listen to black doulas who are saying they need accessible reimbursement systems and to be paid a living wage."

Some chatters noted the need to center pay equity in sustainable funding models. Ancient Song Doula Services, a New York-based doula certifying organization that offers services to women of color and low-income families, and trains community-based doulas to address health inequities, said that "women of color led organizations and stakeholders need to be involved in the process of change to address disparities in real ways not just faces in supervisory roles. We need to #ListentoBlackWomen in the birth room and bring them in the board rooms."

MCH programs can engage in collaborative relationships with community-based organizations by asking what they need and prioritizing funding for community-based and community-led programs. Programs might face barriers engaging with community-led organizations around improving perinatal health or exploring systems of equitable reimbursement for doulas or community health workers. Here are some resources to help:

  • An inconvenient truth: You have no answer that Black women don't already possess. This article emphasizes that thus far, solutions to address disparate perinatal health outcomes have failed to recognize the inherent strengths of Black women. They fail to place them in leadership roles that would allow them to dismantle systems that continue to perpetuate inequitable funding for programs. This is a must-read for MCH workers serious about partnering with community-led organizations to tackle disparities in perinatal health outcomes.
  • Advancing Birth Justice: Community-Based Doula Models as a Standard of Care for Ending Racial Disparities. This report by Ancient Song Doula Services, Village Birth International, and Every Mother Counts outlines the differences between typical and community-based doulas and highlights the governor-driven initiative in New York state to cover doula services through Medicaid reimbursement. The report states that in order to be successful, the New York State Medicaid Doula Pilot must extend services to include community doula models and set reimbursement rates sufficient for doulas to earn a living wage. The report presents important information on the role community doulas play in overcoming the effects of racism and implicit bias for women of color. It also analyzes Medicaid doula programs in New York, Oregon, and Minnesota, citing low reimbursement rates for doulas as a significant barrier to the potential success of the programs.

Send questions and comments to Jessica Huey at jhuey@amchp.org.