The California Birth Equity Collaborative

Improving care for, by, and with Black mothers


The California Birth Equity Collaborative is a quality improvement initiative of the California Maternal Quality Care Collaborative (CMQCC) designed to improve birth care, experiences, and outcomes for, by, and with Black mothers and birthing people1 in California. It is funded by the California Health Care Foundation.

The collaborative team is comprised of partnerships among:

  • Black/Black women-led community-based organizations (CBOs)
  • Participating hospitals
  • State, national, and local advisory groups


Since 1999, the reported maternal mortality data in California show a persistent three- or four-fold gap between Black mothers and mothers from all other racial groups. Maternal mortality rates nearly doubled in California between 1999 and 2006. CMQCC was founded in 2006 at Stanford University School of Medicine together with support from the state of California. Since CMQCC’s inception, California’s  maternal mortality rate has declined by 55% while the national rate has continued to rise. The expectation was that widespread adoption of CMQCC’s clinical safety bundles would reduce the gap in the number of maternal deaths among Black women compared to other groups. However, the difference in outcomes for Black mothers compared with all other racial groups has persisted.

Further analysis revealed that clinical safety bundles and social support interventions done in isolation, without an integrated approach, did not produce the desired outcomes. Thus, CMQCC’s Birth Equity Collaborative presents an opportunity to develop quality improvement tools to promptly evaluate and transform birth care, experiences, and outcomes through the integration of clinical and sociocultural interventions and community-hospital partnerships.

  • Data show that even in the absence of risk factors such as age over 35 years, lack of health insurance, inadequate or no prenatal care, and education below a high school level, the US health care system is not protecting Black mothers and birthing people from experiencing higher numbers of deaths or life-threatening complications during pregnancy and childbirth.
  • Increasing evidence points to racism within and across multiple levels (PDF), and not race, as a key cause of these birth disparities.
  • Data also show variations in the quality of care and outcomes across hospitals in California, highlighting opportunities for advancing equity in quality improvement.

With California Birth Equity Collaborative pilot, CMQCC aims to transform birth care for, by, and with Black mothers and birthing people in California in partnership with Black women-led CBOs, three participating pilot hospitals, and state, national, and local advisory groups. The pilot is expected to run for two years, starting in January 2019. Learn about the core values that inform this project.

CBO Partnerships

Black women-led CBOs and CMQCC can collaborate in two ways:

  1. Development and testing of quality improvement tools and approaches in hospitals in four key areas: evaluation and assessments, education and training, social media and communications, and community-informed consensus building
  2. Development of effective and sustainable community-hospital partnerships through local advisory groups for each of the pilot hospitals

Contact Us

Learn more about the California Birth Equity Collaborative, and follow the work as it progresses.

For information about the pilot, please contact Cathie Markow, administrative director: [email protected].

For information about CHCF’s work to support birth equity, please contact Stephanie Teleki, director of Learning and Impact at CHCF.




  1. We use the term “birthing people” to recognize that not all people who become pregnant and give birth identify as a woman or a mother.