Ciera Baker, a pre-Kindergarten teacher in Raleigh, wanted to stay home for a few months with her newborn baby, but her job doesn’t provide paid maternity leave and she knew she couldn’t get by just on her savings.
Baker’s mother had told her about Equity Before Birth, a nonprofit that helps Black women in the Triangle connect with doulas and lactation consultants, and provides financial support. Equity Before Birth will give Black mothers $2,000 a month for up to three months to allow them spend time at home with their newborns.
“It’s allowed me to stay home with her and bond with her for a little longer,” Baker said. The nonprofit is also helping Baker find a lactation consultant.
Equity Before Birth is among the growing number of nonprofits aimed at supporting Black mothers through their pregnancies and in the months after. Along with the rising interest in doula services for Black women, these efforts are considered important to lowering rates of Black maternal mortality.
Black women in America are three times more likely than white women to die from pregnancy-related causes, according to the Centers for Disease Control and Prevention. The CDC cites the quality of health care, implicit bias, structural racism and chronic health conditions among the reasons for the disparity.
A role for government?
Sen. Natalie Murdock, a Durham Democrat, is co-sponsoring a package of bills aimed at improving Black maternal health and lowering the death rate.
She said in an interview that one of her top priorities is establishing a grant system for community nonprofits that help fill gaps that otherwise leave Black mothers without needed support. “Why not supplement those who can do this work?” Murdock said.
She has filed bills that would give grants to Equity Before Birth and MAAME, a Black doula collective. In addition to the proposals addressing Black maternal mortality, Murdock is also sponsoring a bill to direct the state Department of Health and Human Services to analyze covering doula services under Medicaid.
As with most legislation sponsored by Democrats in the GOP-controlled General Assembly, however, all three measures face an uphill climb.
The bills that would provide grants to Equity Before Birth and MAAME have been assigned to the Appropriations Committee, where competition for inclusion in the final state budget – assuming legislative leaders and the Governor can even reach agreement this year – will be fierce. Similarly, the doula services proposal has been assigned to the Senate Rules Committee – a venue from which bills sponsored by Democrats rarely emerge.
Democrats have also advanced bills for years that would set up paid family leave insurance, but Republican leaders have never allowed the measures to receive serious consideration or debate. This is despite the fact that a 2019 Duke University study found that paid family leave insurance could lead to fewer infant deaths in the state.
In one small step, the state Department of Health and Human Services awarded funds last September to New Hanover Regional Medical Center for doula support and community health workers, using some of the money from a federal Maternal Health Innovation grant. According to the program website, it will serve up to 30 mothers – mostly Black women in New Hanover, Columbus and Pender counties – over two years.
A DHHS spokeswoman said in an email this week that it will award another grant for doula services this year using the federal grant money.
Nonprofits strive to fill the gaps
Community organizations are filling gaps left by governments and employers. Few states cover doulas as a benefit under Medicaid, even though studies have shown that women who receive support from doulas have lower rates of preterm births and cesarean births.
The community-based doula program SistasCaring4Sistas, founded by women of color, provides services through the Mountain Area Health Education Center in western North Carolina. Of 90 patients served through May 2019, more than 93% of babies were born at a healthy weight and more than 87% were full-term, according to MAHEC. All were delivered vaginally and nearly 97% of mothers received prenatal care in their first trimester.
Clients of SistasCaring4Sistas “face some of the greatest challenges in the community accessing care, overcoming systemic racism, and many barriers to employment, education, transportation,” MAHEC spokeswoman Jennifer Maurer said in an email.
MAAME is based in the Triangle but has worked with people from Hendersonville and Roanoke Rapids. Its doulas provide “culturally competent care around the maternal health crisis,” said founder Maya Jackson. “The goal is to create a village around the families we’re supporting.”
Services are provided on a sliding scale, or for free, for up to 18 months postpartum.
MAAME launched a few years ago. Interest in doula services increased during the COVID-19 pandemic, Jackson said, and the group has provided services to 50 birthing people so far.
“People are now paying attention to how bad the maternal health crisis is in this country,” Jackson said. “Black women and Black birthing people are feeling like they’re not being heard. They’re feeling disrespected.”
In addition to providing support during labor and childbirth, the doulas will periodically check in with families after babies are born, and make lactation counseling or mental health referrals if asked. Families are invited to join a Facebook group. It all contributes to creating a cohesive model where families feel supported, Jackson said.
Joy Spencer, executive director of Equity Before Birth, said new mothers have called to tell her they need therapists. “They’re afraid to tell their doctors,” she said.
Equity Before Birth connects parents to services and then covers the costs. The nonprofit has worked with about 35 families since it was founded last year and reports that six or seven have received supplemental income of the kind provided to Baker.
“A lot of people tackle maternal health, financial hardship, or racial equity,” Spencer said. “We’re kind of that perfectly balanced blend of those three.”