The Alliance for Early Success recently partnered with Elephant Circle and the Black Mamas Matter Alliance (BMMA) to host two discussions on the importance of community-driven maternal health solutions. Jacy Montoya Price, the Alliance’s senior director of Advocacy and Issue Campaigns, facilitated the events. Presenters shared projects and strategies they employ to build engagement while forging connections with grassroots, community-based organizations, all to improve outcomes for all birthing people wherever they are along their reproductive life course.
Here are our top 10 takeaways from the conversations:
1. We can look to nature for inspiration. When elephants birth in the wild, the whole herd circles around the laboring elephant. They stay for the entire labor, providing connection, support, protection and defense. “That’s what we think humans need in the perinatal period as well,” Indra Lusero, founder of Elephant Circle, said on August 30. Elephant Circle brings an intersectional, feminist, reproductive justice and design-thinking approach to birth justice to make true transformation possible.
The maternal mortality rate in the U.S. rose between 2018 and 2020, showcasing the impact of the COVID-19 pandemic on the pregnant population and resulting in nationwide health care system disruptions. “Things aren’t fair, things aren’t set up justly and we’ve got to start tackling those big issues,” Lusero said.
3. Black women experience an immense burden. During the September 13 talk, Stephanie Aristide of BMMA explained that gaps in the pregnancy mortality rate between racial groups have widened over the past 15 years. In 2020, Black women were disproportionately affected by maternal death, with a mortality rate of 55.3 deaths per 100,000 live births—a significant increase from 2019.
The work of the BMMA is deeply rooted in reproductive justice, birth justice and the human rights frameworks to ensure that all Black mamas have the rights, respect and resources to thrive before, during and after pregnancy.
4. History offers essential context. “When presented with the appalling statistics surrounding Black maternal health in the U.S., we must always take a deeper dive into the root causes of these issues,” explained Aristide. “The regulation of Black women’s reproductive decisions has been a central aspect of racial oppression in America.”
She provided a number of examples: “Enslaved pregnant Black women were forced to work in plantation fields until their labor, rarely given a chance to rest and bond with their babies and were required to return to the fields with their babies strapped on their backs.”
Aristide continued, “The institution of slavery in the U.S. opened the door for all types of unjust medical experimentation on Black women’s bodies, from experimental vaginal surgeries without anesthesia, to stealing cervical cancer cells, all in the name of advancing science.”
These and other atrocities set the stage for persistent harm to Black bodies. Throughout time, Black institutions such as the Tuskegee Institute, churches, community organizations and Black women’s clubs addressed these issues through health education and preventative service initiatives like the National Negro Health Week in the early 1900s.
5. Equitable health care is a human right. “Human rights is a critical dimension,” Lusero said. “When talking to people about issues facing them in the perinatal period, a sense of justice… is really important. People don’t just want clinical solutions or solutions that are familiar. People want things that get at fundamental, core issues of inequities.”
While equity is top of mind for those navigating the system today, the idea remains elusive. “There’s a lot of interest in health equity, but how health equity can be achieved is not understood,” Aristide explained. “Maternal health is still deeply entrenched in the patriarchal narrative that only cares for women’s bodies in relation to being able to have a healthy baby. And interventions to address adverse maternal health outcomes focus heavily on individual behavior change.”
George Davis, a community advocate with Elephant Circle, mused, “A lot of times, the answers to the problems that we’re looking for have not been thought up yet. We’ve only felt the pain from dealing with this thing.”
6. Solutions exist beyond the status quo. “Policies that only look at services within the traditional medical context are extremely limiting and do not address the core problems of health inequities. They often further aggravate the problem,” Aristide said in the September 13 talk.
Lusero echoed the sentiment on August 30: “If we’re going to change the status quo, we have to innovate. We need new feedback loops. We need accountability.”
Davis pointed out that we must start at the root to inspire meaningful solutions, “So often, things are looked at to be changed on the branches, or the leaves, by pruning, when the problem is so deep in the root. Birth equity and reproductive justice are starting at the root to create change.”
7. Birth work is a powerful pathway. Strong evidence shows that birth work improves outcomes. “Of course, we have to look really largely at the systemic issues behind maternal mortality and morbidity, but birth work is a really important piece of that puzzle,” Lauren Smith of Elephant Circle said during the August talk.
Historically, Black midwives were vital maternity caregivers for communities, especially in the South. Aristide explained, “Over time, discriminatory public policies restricted Black midwives, depleting the maternal care workforce.” BMMA aims to address this gap with its workforce development policy and programming initiatives like the Black Maternal Health Institute and Incubator Hub.
“The goal is to work toward equitable maternal and birth outcomes for Black birthing people through systemic change at the community and state levels.” Milan Spencer of BMMA said. “In very tangible ways, we are building the capacity of our workforce through training and education.”
In addition to this learning space, they annually assemble Black women, clinicians, professionals, advocates and other stakeholders working to improve maternal health at the Black Maternal Health Conference and Training Institute. They host Black Maternal Health Week every April to build awareness and amplify voices.
8. We must listen to learn and learn to listen. “When listening, you’re engaging in a mindset. It requires you to be generous and generative,” Indra said when explaining the power of listening to other people’s stories.
Pia Long of Elephant Circle said, “It’s important that people tell their story, and it’s even more important that we come up with solutions so that we don’t have to keep telling these stories, so that folks don’t continue to have this pain and trauma that happens when they go to give birth in the United States.”
9. Policy efforts should require community input. “Ultimately, all conversations regarding maternal deaths, policy solutions and improvements needed to the systems contributing to maternal mortality should start and end with the community,” said Stephanie Aristide of BMMA.
To inform a set of bills in Colorado collectively called the birth equity bill package, Elephant Circle toured 1200 miles, with stops around the state to engage those who normally don’t have a seat at the table. “By ensuring that community voices and directly impacted people were in every conversation, every stakeholder meeting, it changed the power dynamic at that stage, which helped change the power dynamics reflected in the policies, which helped us pass these bills,” Lusero said.
The essence of the bill package is beyond what’s written into statute. “It’s how we did it and the spirit we brought to it. That’s the spirit we need in the perinatal period, that feeling of being circled around, being part of the herd. Knowing that we have to take care of each other.”
10. Everyone has a part to play in improving outcomes. “You don’t need to be a lobbyist to be an advocate,” Lauren Smith said.
Similarly, you don’t need to identify as a woman to get involved in birth justice work. “As a male, at first, I was like, this isn’t for me. I don’t know what we’re doing. Then I began to listen, ask questions, and study on my own and find out this is exactly where I’m supposed to be,” George Davis said of his experience at Elephant Circle. “In fact, more fathers, men, everyone needs to know about this because this is something that we’re all in together. Reproductive justice, birth equity, we are all born. So it’s a wonderful place to start.”
For those looking to get involved, Milan Spencer from BMMA said, “Our recommendation is to seek out those community-based, grassroots organizations that are leading initiatives locally and get involved in their efforts. Express your passion. Ask what their needs are and what support looks like to them.”
Early Learning Nation columnist Mark Swartz writes for and about nonprofit organizations. Author of the children's books Werner Herzog Eats His Shoe, Lost Flamingo, Magpie Bridge and The Giant of the Flood as well as a few novels, he lives in Takoma Park, MD, with his wife and two children.