Everyone deserves access to respectful care and strong community support during pregnancy and birth. Tapping into local wisdom can create a future where all parents receive the care they deserve during and after pregnancy.
An illustration suggests that care should be collaborative, safe, and culturally inclusive through every stage of pregnancy.
Access to dignified healthcare and supportive community conditions during pregnancy and birth should be a basic right. This means having safe housing, nutritious food, and social services that support the health of the child and parent. The stark reality, however, is that structural racism continues to drive disparities in care for people of color and requires a systemic approach to improve health outcomes. Community-driven solutions and policies can better support everyone, regardless of race, class, needs, or other factors.
To remove barriers intentionally created to deny high-quality healthcare to people of color, the Systems for Action Research program is building strong evidence to better align delivery and financing systems for medical care, public health, and prevention, as well as social and community services.
Grantees from its programs—along with researchers from Evidence for Action and Policies for Action—share promising research on three ways to improve health outcomes for birthing people through cross-sector alignment, culturally resonant approaches, and policy solutions:
1. Creating safe and culturally inclusive spaces
Dr. Malini Nijagal, M.D., M.P.H., an OB-GYN at San Francisco General Hospital and UCSF Health, champions the “Pop-Up Village" model to connect healthcare providers and the communities they serve. Research shows that this one-stop shop for new mothers also leads to greater health equity.
This model integrates medical services with essential resources like food and housing, all within a community-based, culturally sensitive, and welcoming environment. Dr. Nijagal and her team have transformed how they provide care to better match community needs by partnering with other organizations that provide services such as food access and housing support in the same location. In this way, Dr. Nijagal’s team can easily talk to partners providing housing and food services in real time, making it easier to work together and coordinate efforts. This approach fosters better collaboration and stands in contrast to traditional health spaces that reflect a dominant, largely white, heteronormative, and neurotypical set of experiences. A key takeaway her team discovered is to bring healthcare to the community—spaces where they live, feel safe and comfortable—and take it out of traditional healthcare settings. “People don’t feel safe if they have to go to a physical environment where historically they haven’t been safe,” Dr. Nijagal says.
2. Comprehensive cross-sector care models can reduce life threatening disparities
Felix Muchomba, Ph.D., M.P.H., assistant professor at Rutgers University School of Social Work, has been looking closely at local policy levers that influence the health of birthing people in New Jersey. Despite having one of the lowest poverty rates and highest median incomes in the United States, New Jersey has the fourth-highest mortality rate and one of the highest morbidity rates for birthing people in the nation.
After mapping maternal health in New Jersey, Muchomba found that the way a city puts together a budget with housing subsidies and other social services can significantly reduce maternal morbidity, underscoring the importance of cross-sector care models. His research, published in JAMA, shows that adding $1,000 annual per capita spending on housing and social services can significantly reduce life-threatening outcomes of labor and delivery.
3. Community-informed research can improve outcomes
Venice Ng Williams, Ph.D., M.P.H., assistant professor of pediatrics at the University of Colorado, Anschutz Medical Campus, is part of a team doing research on Aligning Health and Social Systems to Expand Evidence-Based Home-Visiting.
Evidence-based prevention programs—like Nurse-Family Partnership, which offers free care to first-time pregnant people from nearby prenatal nurses—are critical for improving the health of families facing adversity. These programs are most effective when families participate in setting goals and creating care plans that meet their unique needs, and providers across sectors are aligned in delivering complementary services. Including the community in collaborative research informs culturally relevant practices that lead to better program engagement and outcomes. One way in which her team has engaged the community is by recruiting and training family leaders to participate on an Advisory Committee to inform research questions and priority outcomes. Newly published research outlines specific ways that cross-sector collaboration can improve health and wellness for families.
What Policymakers, Practitioners, and Community Leaders Can Do
To break down barriers to care, policymakers and community leaders must work together to:
Develop local policy solutions
Local policies are key to improving health outcomes for birthing people. Muchomba's work demonstrates that people who live in places with higher local spending have better outcomes. Reforms aimed at delivering care in diverse settings, coupled with a focus on trauma-informed approaches, are essential. It is important to emphasize local government solutions, as there is significant variation between local and federal spending.
Leverage Medicaid funding
On the other hand, Medicaid funding is crucial to expand support services for birthing people, like doula care and access to nutritious food. Funding these and similar services through Medicaid can address health disparities by improving access to resources and information for birthing people.
Co-create solutions with local communities
One way to create lasting change that improves care for birthing people is to work together with the community facing challenges to find solutions. Although not a new concept, this collaborative approach is crucial and resonates widely. Effective methods include the relational model of change and the Stepping Up and Speaking Out resources from Michigan.
Nurture ongoing relationships
Establishing relationships should not merely be an initial phase of the work, but a continuous and integral process. Deeper relationships advance the work and play a crucial role in fostering and maintaining trust.
By embracing human-centered design principles, actively engaging with local policies, leveraging Medicaid funding, and working with communities, we can pave the way for a more inclusive and effective healthcare system for all birthing people. Together, we can create a future where all parents receive the care and support they deserve during and after pregnancy.
Birth justice organizations are making access to supportive, dignified healthcare during pregnancy a reality.
About the Author
Carrington Lott is deputy director of Systems for Action, managing daily operations including grant-related communication, stakeholder relationships, the Call for Proposal process, and more.