2023 RWJF Culture of Health Prize Winner
In Los Angeles County, Birth Justice Is Black-Led and Joyful—and It Takes a Village
A single-story green home with a beautiful garden and a wide, inviting front porch is the site of joy and justice. Here at the CDU1 Black Maternal Health Center of Excellence, Black parents from across Los Angeles County have prenatal appointments with midwives and others in their “village,” find support for their mental health, and connect with one another on their infant feeding journeys. Beyond offering essential care for Black parents preparing for birth, the space is a flagship for the African American Infant and Maternal Mortality (AAIMM) Prevention Initiative, a Black-led coalition of the Los Angeles County Departments of Public Health, Health Services, and Mental Health; First 5 LA; community- and faith-based organizations; and healthcare providers, birth workers, funders, universities, and community members.
Initiative leaders know that healthy births are possible when systems in Los Angeles are redesigned so that nothing stands in the way of Black families, birth workers, and Black communities, especially discrimination and bias baked into healthcare systems. Partners see that tackling structural racism that harms Black families will improve policies and systems and advance health equity across the region. Listening to people who have firsthand experience is key to the initiative’s approach. “We’re looking at ‘how are we strengthening the village?’ We’re not here to replace the village; the village has been here. We’re here to be strategic in the ways we can fill gaps and expand capacity where it’s needed,” explains Brandi Desjolais, co-founder and co-director of the Black Maternal Health Center of Excellence and a member of the AAIMM Steering Committee.
1 Charles R. Drew University of Science and Medicine
Davion Mauldin, fatherhood coordinator for AAIMM, hosts a meetup for Black fathers in Compton, California.
Participants at the Black Women for Wellness Breast Health and Art Event share dialogue about environmental justice, health, and community.
Expecting parents meet with their doula, Lakeisha Solomon, who is instructing them on managing pain during labor. Lakeisha is one of many Black doulas working with AAIMM in Los Angeles.
The AAIMM Prevention Initiative takes action from Community Action Teams and provides input from members of the AAIMM Steering Committee who have lived experience. This is just one way the initiative provides responsive support to people in the community and keeps the organization true to AAIMM’s roots. The initiative stemmed from public health and community leaders advocating a different, collective approach to supporting Black maternal and infant health. Adjoa Jones, director of community outreach and engagement of the Los Angeles County AAIMM Prevention Initiative and lead of South Los Angeles/South Bay AAIMM Community Action Team, shares, “I thought about myself, and I thought about people I know, and I said, ‘I haven’t seen a difference in [Black infant and maternal mortality] rates in our county for over 25 years. Something has to be done differently.’ This is what happens when someone finally says, ‘You know what, we are not going to be able to continue doing it this way and think that we’ll have success.’”
Taking a new approach meant focusing on dismantling structural racism within systems and policies, spanning far beyond policies that solely impact reproductive health and rights and beyond Black birthing families in the region alone. Community input pushed partners, including the Los Angeles County Department of Public Health and First 5 LA, to name racism as a root cause of birth injustices. This shifted the focus away from strategies that inherently blamed and shamed people for the inequities they were experiencing toward addressing structural racism in systems, including implicit bias in healthcare. In its initial design, the initiative sought to establish collaboration among community leaders, birth workers, and the Los Angeles County Department of Public Health. It places a priority on addressing toxic stress caused by experiences with structural racism among Black families, which researchers coined “weathering.”
It’s critical to keep our community engaged and informed. I want to ensure that other mothers like me have options—support, love, equity in care, and resources at their reach to create healthy and loving environments for themselves and their children. We’re building coalitions and increasing that support.
—Adjoa Jones, director of community outreach and engagement of the Los Angeles County AAIMM Prevention Initiative and lead of South Los Angeles/South Bay AAIMM Community Action Team
The initiative’s public communications followed suit by interfacing directly with Black families who give birth in Los Angeles County and calling people to boldly embrace an optimistic vision of joy and justice. The partnership offered resources and celebration during Black Maternal Health Week and continually calls for justice through solidarity when holding hospital systems accountable. AAIMM is part of a global movement for birth justice, with longstanding roots in Los Angeles County and in reproductive justice movements. Community accountability and action fuel continued movement-building. Community Action Teams hold regular community meetings with current and future parents, birth workers, community-based organizations, and health partners; and during COVID-19, they adapted to virtual platforms. “It’s critical to keep our community engaged and informed. I want to ensure that other mothers like me have options—support, love, equity in care, and resources at their reach to create healthy and loving environments for themselves and their children,” says Jones. “We’re building coalitions and increasing that support.”
The AAIMM Doula Program was developed specifically to address racial disparities in pregnancy, labor, and postpartum periods. The program has provided free, culturally relevant doula support to more than 500 Black pregnant people in Los Angeles County since 2019. Melissa Franklin, director of maternal, child, and adolescent health for the Los Angeles County Department of Public Health, describes the partnership’s efforts: “It’s not just program design. It’s solidarity. It’s relationships. It’s hearing each other’s dreams and truly supporting them.”
In the same spirit of “it takes a village,” The Village Fund, a public-private partnership to support community-led efforts that reinforce AAIMM’s goals, was created with $300,000 from donors, including the Los Angeles Department of Public Health and First 5 LA. The fund has sponsored projects such as Mighty Little Giants, which provides support for families of color with preterm newborns in neonatal intensive care units. Community Action Teams, with support from the Perinatal Equity Initiative, are also working across regions to support expectant fathers and partners. One of those efforts is a Juneteenth Father’s Day community celebration in South Los Angeles. Another is a five-week Expecting Fathers group for Black dads, in which other Black dads provide support and share navigation tools that focus on the prenatal, labor and delivery, postpartum, and early parenting periods.
A breastfeeding mother ducks in to AAIMM’s Safe Space Breast/Chestfeeding Tent at the Taste of Soul Family Festival in Los Angeles.
A family of five with three young children hike the Baldwin Hills Scenic Overlook Trail in Los Angeles, California.
AAIMM is a coalition of the LA County Health Agency, First 5 LA, community organizations, mental and healthcare providers, funders, and community members.
Dismantling structural racism within healthcare systems requires a multipronged approach, including policy change, antiracism training for county staff and clinical providers, and wrapping resources around families who are navigating healthcare systems. “I think we need to do a lot of things at the same time because there isn’t just one way we experience racism,” shares Nicole Jones, program officer at First 5 LA. “Racism comes at us from all corners of society.”
AAIMM’s vision is simple and bold: People across Los Angeles County can stop injustice by working together to ensure that Black families have access to safe and joyous births. Quality care can be delivered with respect and dignity. Laws and policies can place power in the hands of families and address unfair treatment. Healthy births take a whole community.
“We’ve kept a hold of the values our partnership co-developed very firmly, and that’s been a point of solidarity for us,” Franklin says. “We believe that racism is a root cause. [We believe] in Black folks up front and leading, in fighting inequity while fighting for equity. We know that we’re all pieces of a puzzle; this isn’t just an issue for Black people to solve. And finally, we believe in transforming systems, not people. This isn’t a blame game. Black people don’t need to change. Our systems do.”
