Kenyatta Casimir and her partner were thrilled when they found out they were pregnant—but as a Black woman, Kenyatta also felt concern. She was keenly aware that her risk of experiencing pregnancy-related complications was high. It didn’t matter that she was young, healthy, and informed. She knew that for her, having a baby in the U.S. - and in her case, twins - was a risk. Her chances of being dismissed or mistreated by her doctor and care team were high and the possibility of being referred to a specialist if needed was lower than others.
Kenyatta worked in health care and wanted help advocating for herself and her family as she gave birth. She found a doula through a network in her area called JUST Birth. Founded in 2022, JUST Birth helps improve the birthing experience of Black and Indigenous People of Color (BIPOC) in Seattle. She worked with the program throughout her pregnancy, birth, and the post-partum period. Several months later, her twins were born and everyone, including Kenyatta, was healthy.
JUST Birth and programs like it are ensuring more pregnant patients like Kenyatta have positive outcomes. In fact, leaders from the Centers for Medicare & Medicaid Services (CMS) visited JUST Birth last summer and replicated some of the program’s core pieces in a new funding model called Transforming Maternal Health (TMaH). TMaH offers financial incentives to support a comprehensive approach to pregnancy, birth, and post-partum care, including access to midwives, doulas and perinatal Community Health Workers.
The model is an important step forward. Along with connecting birthing people to doulas and midwives, it aims to improve prenatal care, particularly around chronic conditions like hypertension and diabetes, and to reduce the number of c-sections and other complicated procedures.
At a time when maternal mortality in the US continues to climb, we must use every effective, evidence-based tool at our disposal to lower rates. Access to resources like doulas and midwives can be incredibly valuable for pregnant people. These highly trained professionals help people navigate the health care system, assisting at every stage of pregnancy. There is strong evidence indicating that midwifery and doula care helps reduce cesarean and premature deliveries, increase breastfeeding success and decrease anxiety and stress during labor and the postpartum period. This is particularly relevant for people of color, who face structural racism that has created inequities in birth outcomes, including a significant rise in maternal mortality rates.
When the CMS application period opens later this spring, qualified state Medicaid programs will have an opportunity to apply for funding to support evidence-based, wraparound services that can improve disparities in maternal mortality rates among Black people in particular.
While reversing the broader U.S. trend of adverse pregnancy outcomes will not happen overnight, complacency is simply not an option for mothers like Kenyatta who continue to face major obstacles and heartbreaking realities. We must work together to eliminate the systemic inequities that impact care across the country for pregnant people of color. While ultimately, Kenyatta’s pregnancy went smoothly and she delivered two beautiful and healthy girls, the outcome could have been, and too often is, much different.
There are many organizations, agencies, health systems, and community organizations working to bring us closer to the transformative change we need to see in maternal health care—change that we’re already starting to see in Washington state. Together, we can create a more inclusive and empowering experience for all pregnant people.