Adequate access to resources such as child care, nutritious foods, and housing can help people of reproductive age and their families lead healthy lives. However, these resources are not sufficiently available across all geographic areas and communities in the United States.
People in these underserved communities—who have historically been disproportionately affected by rigid policies, minimal support services, and limited provider hours and locations—are at greater risk of negative maternal and infant health outcomes, such as birth and postpartum complications. Those living in rural areas, people of color, and individuals experiencing language and cultural barriers are particularly at risk, and COVID-19 has further exacerbated these disparities.
To improve maternal and infant health, organizations and agencies can design systems of care that are responsive to client and community needs. Using a multidisciplinary approach, these parties can work to better coordinate and integrate service design and delivery while creating structures that engage community voices.
Health Impact Project-supported teams in Virginia and Washington state are taking this approach as part of the Calling All Sectors Initiative—a collaboration of cross-sector “core teams” in nine states and Washington, D.C., working to address maternal and child health issues. At the center of their efforts, these teams are helping to connect state agencies, community-based organizations, and health providers to the groups they serve. Research has shown that community involvement helps institutionalize best practices in health programs and services. And policies and programs are most effective when informed by the people they affect and when equity strategies are built in to tackle drivers of health disparities.
In Virginia, the core team is working to address root causes of racial disparities in severe maternal and infant morbidity and mortality with attention to racial equity and community voice. Inequities across maternal and child health are persistent in certain areas across the state, particularly among low-income and minority groups. A recent needs assessment identified health inequities, health care infrastructure, and coordination as priority needs among Virginia’s maternal and child health programs and providers.
To address these inequities, the team is strengthening partnerships between hospitals and community-based organizations by collaborating with the Virginia Department of Health, which works with the Virginia Hospital and Healthcare Association Foundation (VHHAF), the Virginia Neonatal Perinatal Collaborative, and other partners. Together, these groups support VHHAF’s Maternal Health Collaborative (MHC), which aims to ensure that maternal populations have access to community resources such as stable housing, income, food, and a continuum of health care.
The VHHAF MHC fosters partnerships between hospitals and community-based organizations, ensuring that individuals are supported prenatally, throughout pregnancy, and in their first year postpartum. This includes providing hospitals with technical assistance as they conduct data analysis, assessing their adherence to culturally and linguistically appropriate services (CLAS) standards (15 action steps to advance equity in health and health care organizations ), and delivering racial equity training. The collaborative also works with community organizations to develop work plans that address factors outside the hospital that are contributing to inequities in birth outcomes. These work plans include efforts to assess social needs, provide care coordination, and help connect patients with resources and organizations that have trusted relationships with community members.
The Washington state core team seeks to improve outcomes for birthing people and their infants by identifying and aligning policies and enrollment opportunities in family support programs across state agencies, such as the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).
Data from the state’s Infant Mortality Reduction report showed the infant mortality rate for African American babies is twice that of White babies—a racial disparity that has persisted over the last decade. The report’s recommendations included strengthening care coordination by aligning health programs that contribute to protective factors and improving support for infants and families at highest risk of poor birth outcomes.
The WIC program has low African American enrollment rates in some counties despite high rates of eligibility. To improve access to WIC services for eligible families, the core team is exploring ways to include community voices, such as reviewing existing community assessment data to better understand what participants identify as strengths, needs, and priorities. The team is also establishing a participant advisory committee to understand the role that internal and external policies play in access to services, including eligibility criteria and geographic areas of focus.
Byrd Barr Place—a nonprofit organization that provides direct services and creates sustainable, equitable improvements for the African American and Black communities—is the Washington state team’s community partner. Together, they are working with families to develop best practices for engaging communities in trusted partnerships to inform and guide the WIC program’s work.
Increasing healthy birth outcomes by improving systems of care is a complex process. It requires that state agencies, local groups, and their partners center community voices to build cross-sector relationships, trust, and understanding. The Washington state and Virginia teams are coordinating such partnerships and initiatives to leverage state and local data sources, identify gaps in services, and improve alignment and integration of partners and programs—efforts that can help parents and infants live their healthiest lives.
Maura Dwyer is a senior manager and Kerk Allen is a principal associate with The Pew Charitable Trusts’ Health Impact Project.
