This commentary by Generate Health is part of Partners in Maternal Health and Birth Justice, an ongoing series spotlighting community-based organizations that work toward maternal health equity.
Across the United States, policymakers and health care providers are finally waking up to a reality that Black families have known for a long time: adverse maternal and infant health outcomes disproportionately affect Black women, birthing people, and their babies. From the social determinants of health, such as access to safe housing and reliable transportation, to care delivery for pregnant and postpartum people, our systems have continued to fail Black families.
In St. Louis, Generate Health—a non-profit that envisions a future where Black families thrive before, during, and beyond pregnancy—aims to change these outcomes. Generate Health is in a unique position: we do not provide direct services to families, but instead convene St. Louis’s maternal and infant health providers, advocates, and community members. As a coalition, we create spaces for collaboration and accountability to improve the experience of pregnancy and parenting for Black families in our community.
Centering Black Families in St. Louis
After the murder of Michael Brown in nearby Ferguson, Missouri, Generate Health staff reevaluated our mission to serve all babies and families in our community and saw that our equality-based approach was not creating equal outcomes for Black moms and babies.
Black women and birthing people are more than three times as likely to die as a result of pregnancy. Black babies born in St. Louis are three times more likely to die before their first birthday and five times more likely to die of unsafe sleep situations than white infants. These health outcomes are driven by both social and structural determinants of health like racism, classism, and sexism. Black women and birthing people consistently encounter providers who not only don’t look like them and have little experience connecting with people of color: those providers have also been trained in a medical system that regularly discounts Black lives.
Black women and birthing people consistently encounter providers who not only don’t look like them and have little experience connecting with people of color.
To address these disparities, in 2018, we officially changed our mission to center racial equity over mere equality, and created opportunities for impacted communities—primarily Black women and birthing people—to have decision-making power in our coalition. We believe Black pregnant and parenting people need to lead the discussions and set the direction of how resources flow into their communities and directly impact their health and health care. To live into these beliefs, we created a Community Leaders Cabinet in 2019, primarily made up of Black people with lived experience, who have shaped our organizational priorities. These community leaders elevated the need for coordinated quality care for Black women, birthing people, and their babies as a top priority; in particular, the urgent need for improving access to culturally congruent prenatal care, home visiting, behavioral health, safe sleep education, and doulas.
The Birth of the Bloom Network
These recommendations culminated in the creation of The Bloom Network, an initiative that convenes community members and care providers to both reimagine and create better care delivery for Black families. Since 2020, The Bloom Network has been redesigning and redistributing resources to promote equitable infant and maternal health outcomes by taking the following steps:
- Remake who is leading systems-change work. In addition to preparing community members to lead decision-making about programs and services, providers must be equally prepared to shift power and support new models of community leadership. This requires providers to shift mindsets and dismantle the systems that have perpetuated inequity.
- Improve culturally congruent care. The call from our community leaders has been clear: providers and provider organizations serving Black pregnant and parenting families must adopt holistic, barrier-free, culturally congruent approaches to care and to operate in a coordinated service delivery system.
- Increase trust between community and providers and increase engagement in services. As services become more culturally congruent and providers work to earn the trust of families, more parents will engage in services and receive support during a vulnerable time.
- Seamlessly enter families into a variety of support systems through stronger partnerships and referral networks. Once the Bloom Network has established service delivery coordination across behavioral health, home visiting, and safe sleep, it will be positioned to intentionally link with other perinatal service delivery systems, such as doulas and prenatal providers. In addition, coordinated service delivery systems will be better able to connect and broker support for clients with other sectors that impact maternal and infant health, such as housing, food, transportation, and early childhood education.
- Share data to show opportunities for accountability while avoiding duplication of resources and ensuring services are directed where they are most needed. The network coordination approach multiplies impact across the service delivery system, which accelerates change. Centralized data that is interpreted in collaboration with the community can illuminate how to direct the right support at the right time.
Initial Impacts, and Looking Forward
In the first three years of the Bloom Network, we have created opportunities for Black pregnant and parenting families, service providers, leadership of provider organizations, and funders to share space and learn from one another. We have also coordinated trainings for the maternal and infant health workforce to learn how to provide high-quality, culturally congruent, evidence-based, and anti-biased services. Throughout, we have prioritized the training topics identified as most desirable by Black people with lived experience.
Early experience shows that small shifts are taking place. Providers are asking for advice about what they need to change about their services, rather than how to change consumers. The Bloom Network has been sought out by local providers and national efforts to learn from our community engagement efforts to shift power and build decision-making structures where community voice is centered. Providers that have attended anti-bias trainings are asking for more. We now have one centralized system for Black families to sign up for home visiting services delivered by our partners.
We have seen that centering community leads to equitable and safe health care choices for Black women and birthing people. Shifting funding structures and decision-making power so that Black families have autonomy over their health care will help Black moms and babies not only survive, but thrive.
Shifting funding structures and decision-making power so that Black families have autonomy over their health care will help Black moms and babies not only survive, but thrive.
Our dream for the next phase of The Bloom Network is to grow our funding capacity and establish an emergency response fund to support Black families that receive services through the network. The goal is to one day be able to provide rapid response funds for community leaders who may need assistance, aid for families experiencing a housing emergency, or transportation for parents that need to get to appointments. Unrestricted funding is ultimately what would make this dream possible. In the meantime, we continue our work of changing and advocating for systems that better support Black families in St. Louis.