Maternity Care Gets a Racial Justice Focus

Black birth workers give mothers of color healthier, safer options for labor and recovery.

Mamatoto Village was created with the specific needs of Black women and infants in mind.

Photo by Fuse/Getty Images

Tangiere Jones was a 26-year-old mom-to-be when she first heard about Mamatoto Village, a nonprofit that provides birth support for underserved women in Washington, D.C. She wanted the best outcome for the birth of her daughter but faced financial barriers as a substitute teacher who was the sole earner of her household.

Like many Black mothers, Jones was aware of the risks of “birthing while Black.” For instance, the rate of maternal mortality is more than three times as high for Black women than for White women, while the infant mortality rate for Black babies is more than twice as high as the rate for White babies.

“I had been doing a lot of research on having a natural birth, and I knew that I wanted a [labor assistant], but I also knew that I couldn’t afford to pay for one. I had Medicaid at the time, and because they accepted it, I didn’t have to pay anything out of pocket, which was a complete blessing to me,” Jones explained.

The rate of maternal mortality is more than three times as high for Black women than for White women.

Last year alone, Mamatoto Village served 462 women. Of those women, 74 percent of women gave birth vaginally and 89 percent initiated breastfeeding, a noteworthy feat considering that the national rate for Black women is 64.3 percent, the lowest of any group.

Mamatoto aims to address the physical, mental, and emotional challenges moms-to-be face, and to assist with the economic ones. Of their clients, 89 percent are Black, 60 percent are unemployed without income, and 22 percent have a history of reported abuse. The staff provides pregnancy and breastfeeding education classes and emotional counseling.

Perinatal community health workers at Mamatoto undergo an intensive individualized in-house training program to become labor and postpartum assistants, perinatal and childbirth educators, or lactation coaches. Courses cover topics like the history of reproductive health for women of color, the intersection of health equity and reproductive justice, and cultural competency and cultural humility.

Executive Director Aza Nedhari, a midwife and mother of three, created Mamatoto Village in 2013 (the name translates to “the connection between mother and baby” in Swahili) with the specific needs of Black women and infants in mind. Nedhari used a midwife with her first two births but went unassisted with her last child. All three deliveries were normal and healthy, but she desired to create something more holistic.

“It’s not a model of saving, but more a model of lifting up,” Nedhari added.

Before working for Mamatoto, Brianna Green had been a corporate attorney and involved in real estate. Now as a perinatal community health worker, she ensures that the mom is prepared for labor and delivery by providing education, assisting in birth planning, evaluating the mom’s relationship with her provider while supporting her in decision-making, and providing labor support.

Mamatoto aims to address the physical, mental, and emotional challenges moms-to-be face, and to assist with the economic ones.

In switching disciplines, Green has been able to find an impactful way to engage with local mothers. The most rewarding part for her has been seeing the transformation that occurs among teen moms, “who, when I meet them, are totally unsure of what they are about to undergo, what changes are coming their way,” she said. “But after working with me and their team, [they] stand in their power as mothers, advocate for themselves, birth their babies on their terms, breastfeed with confidence, and make steps that allow them to create stable lives for themselves and their babies. It always makes me proud to see how far they come.”

Mamatoto Village often provides resources that would be hard to find otherwise. For example, its Mama Baby Pamper Day offers the opportunity for moms to relax, eat healthy food, and take part in free or low-cost services like hair care, acupuncture, and belly painting while they attend educational workshops from birth experts. Jones, who was seven months pregnant at the time, was able to schedule a licensed massage practitioner, sign up for childbirth education classes, and even receive discounted photography services.

Funding can be an obstacle for this model of care. The nonprofit primarily serves low-income areas that rely on Medicaid for assistance. To alleviate the burden for patients, Mamatoto has a sliding fee scale and often depends on fundraising and grant funding, neither of which is easy to secure. This model is even hard to replicate in states that require Medicaid reimbursements or are one of 15 states that chose not to expand Medicaid.

But Mamatoto continues to support its clients well after birth. As Jones later faced challenges with breastfeeding and when she needed housing and mental health support to leave an abusive marriage, birth workers helped her get in contact with the District Alliance for Safe Housing, a resource for domestic violence survivors.

Eleven months after leaving, Jones has a full-time job and she and her daughter have their own place. She has become an advocate for women’s holistic health and is working on her own project, Transparency Saves Lives, to increase awareness and support for abuse victims.

“I truly felt cared for and welcomed into a family of women who knew nothing about me but treated me as one of their own,” she said.