Birth Equity

• Reproductive Health Impact (RH Impact), formerly known as the National Birth Equity Collective, partnered with the National Committee for Quality Assurance (NCQA) to develop a national birth equity quality framework and strategy for measuring birth equity and promoting aligned goals to facilitate synchronized actions across the health care system. In addition to CHCF, the RH Impact and NCQA partnership was cofunded by the Pritzker Children’s Initiative, Robert Wood Johnson Foundation, and W. K. Kellogg Foundation. (2023)
• The Maternal, Child, and Adolescent Health Division of the California Department of Public Health released a report detailing the myriad ways that structural racism shapes Black maternal and infant health at the societal, neighborhood, family, and individual levels. The report was developed in collaboration with the UCSF Center for Health Equity, Black Women for Wellness, and a statewide group of Black women leaders and academics. (2023)
• The CHCF Almanac report Maternity Care in California — 2023 Edition provides an overview of the delivery of maternity care in California, including statewide data that highlight disparities in maternity care and maternal outcomes. (2023)
• Black Women for Wellness led an effort to convene an independent advisory committee of Black community leaders and members to inform the UCSF Center for Health Equity as it developed a draft report for the California Department of Public Health on Black maternal and infant health. (2021)
• A research team led by Karen A. Scott, MD, MPH, at UCSF conducted the SACRED Birth Study to develop patient-reported experience measures to solicit feedback (via a survey) specifically from Black mothers / birthing people about their hospital care experiences, with the goal of informing quality improvement efforts in the hospital. (2021)
• The California Maternal Quality Care Collaborative (CMQCC) developed a birth equity dashboard in its maternal data center that contains data from hospitals representing 95% of the births in the state. Currently, these data are available to CMQCC’s hospital members for quality improvement purposes. (2019)
• The Listening to Mothers in California survey (cofunded with the Yellow Chair Foundation), fielded in English and Spanish by the National Partnership for Women & Families, highlights the attitudes and experiences of mothers around maternity care. Black mothers / birthing people were oversampled, and an issue brief (PDF) detailing findings is available, along with many other resources. (2018). The 2024 Listening to Mothers national and California-specific surveys are underway with CHCF support. (In process)

The maternal health care workforce can provide better care by reflecting the diversity of the birthing people it serves, as well as the diversity of provider types that evidence shows yields strong outcomes.

Doulas

• R.A.C.E. For Equity is providing technical assistance and facilitation support services to the California Department of Health Care Services (DHCS) and the DHCS Doula Stakeholder Workgroup to ensure effective communication and successful development of the State Plan Amendment and Medi-Cal Provider Manual for the new Medi-Cal Doula benefit effective January 1, 2023. CHCF also is providing direct support to some doula members of DHCS’s advisory committee to ensure solutions are community-informed and engaged. (In process)
• The National Health Law Program (NHeLP) conducted a landscape analysis to get a baseline understanding of the demographics and composition of California’s doula workforce (PDF). Growing a strong and racially diverse doula workforce throughout the state will support the successful implementation of the Medi-Cal doula benefit by the California Department of Health Care Services. (2024)
  Previously, NHeLP conducted focus groups to better understand the on-the-ground issues (e.g., scope of practice, training and certification, reimbursement) impacting doulas in California. It produced educational materials for key decisionmakers, including policymakers, to help inform the discussion about Medi-Cal coverage for doulas. (2020)
  It is now leading work to select early lessons learned from community doula pilots in California. (In process)
  NHeLP also led work to document early lessons learned from community doula pilots in California. (2022)
• Researchers at the School of Public Health at UC Berkeley conducted research to document the perspectives of payers regarding investment in community doula care in California. They focused on understanding the facilitators and barriers to community doula care (PDF). (2023)
• The StarLion Collective conducted a process evaluation of Health Net’s community doula pilot. (2022)
• The Center for Health Care Strategies conducted an environmental scan of state Medicaid efforts to cover doula services. The project produced a white paper, Covering Doula Services Under Medicaid: Design and Implementation Considerations for Promoting Access and Health Equity, to help California stakeholders understand approaches from other state Medicaid programs and incorporate their lessons into Medi-Cal’s efforts to include doula services and promote health equity. (2022)
• Diversity Uplifts led an effort to support Black mothers / birthing people during the COVID-19 pandemic in several ways, including providing virtual doula care in five California counties (Alameda, Contra Costa, Los Angeles, Sacramento, and San Bernardino / Riverside) and establishing a statewide doula hotline. (2021)

Midwives

• The California Nurse-Midwives Foundation is working to increase access to midwifery care through Medi-Cal and providing policy guidance related to innovative practices and racial equity. The Foundation is also working to ensure that local midwifery services and obstetric care options are available and accessible across the state.  (In process)
• The California Nurse-Midwives Association and faculty in the department of sociology at California State University East Bay are researching the barriers and facilitators to California-based midwifery practices that serve as preceptors for midwifery students. (In process)
• The UCSF School of Nursing’s Nurse-Midwifery Program and Cal State Fullerton School of Nursing’s Nurse-Midwifery Program are collaborating to run the Midwifery Mentoring and Belonging Program, an effort to mentor, retain, and launch nurse-midwives of color in their careers. (In process)
• The California Nurse-Midwives Foundation is leading work to implement SB 1237 (the nurse-midwives scope-of-practice bill), support access to quality reproductive health and maternity care in the community, and engage its own staff in anti-racism training. (In process)
• Californians for the Advancement of Midwifery is engaged in work with an external consultant to set near- and long-term goals, develop a sustainability plan, and build its leadership team to execute. (In process)
• Researchers at the UCSF Philip R. Lee Institute for Health Policy Studies surveyed nurse-midwives and licensed midwives in California to describe their practice, the populations they serve, facilitators and barriers to their work, and intentions for future practice. (2024)
• Purchaser Business Group on Health developed resources to promote access to and use of certified nurse-midwives (CNMs), as well as tools to assist providers in integrating CNMs into their practice. (2020)

Cross-cutting workforce

• The California Black Women’s Health Project provided training and support to Black birth workers who supported Black mothers / birthing people in the early years of the COVID-19 pandemic. The trainings covered maternal mental health, capacity building for virtual care, and virtual safe spaces to help address stress and burnout during the pandemic. (2021)
• The National Association to Advance Black Birth is developing and piloting a training program for labor and delivery nurses that is centered on the Black Birthing Bill of Rights. (In process)
• Reproductive Health Impact (RH Impact) published a free visual resource (PDF) to educate mothers, birthing people, and health care stakeholders about the diverse range of health care workers available to support pregnancy, infertility, loss, abortion, and the postpartum period. Care providers featured in the e-book include ob/gyns, midwives, doulas, childbirth educators, lactation professionals, pelvic floor therapists, mental health professionals, maternal-fetal medicine specialists, labor and delivery nurses, pediatricians, and anesthesiologists. (2023)
• The Urban Institute conducted a study to understand training and workforce pathways that develop and retain Black maternal health clinicians (e.g., ob/gyns, registered nurses, midwives) in California. The resulting report includes actions that federal and state policymakers, higher education and health system leaders, and philanthropies can take to address structural barriers to entering and staying within the field. (2023)

Providers need assistance to improve birth equity. CHCF supports on-the-ground efforts to help individual providers and health care systems improve care delivery and to try new, innovative models.

• The California Department of Health Care Services (DHCS) is implementing the Birthing Care Pathway, a multi-year, comprehensive approach to modernizing maternity care in California. With CHCF support, DHCS is focusing on behavioral health care, home visiting services, and trauma-informed perinatal services. (In process)
• CHCF is funding learning from and evaluation of several prenatal and postpartum programs:
  • Two that are expressly Black-centered
    • EMBRACE
    • BElovedBIRTH Black Centering
  • One that supports underresourced communities
    • Pop-Up Village

• Cherished Futures for Black Moms & Babies, a multisector collaborative in LA County, is working with key decisionmakers from local delivery hospitals, public health departments, health plans, and Black community leaders to implement systems-change interventions at the clinical, institutional, and community levels. CHCF is providing funding to support the core effort, an evaluation, and the development of a hospital-community engagement toolkit. (In process)
• Led by Rachel Hardeman, PhD, MPH, a team at Diversity Science developed a set of online learning (e-learning) modules to assist hospitals in meeting the stipulations of California’s SB 464, which requires hospitals to train their maternity care staff on implicit bias. The first set of modules were developed with stakeholder input and was followed by a California Department of Justice investigation into hospital compliance with the law. (2021)
  • SB 464 also requires perinatal providers to complete an annual “refresher course,” which Diversity Science launched in 2024. CHCF is now partnering with Health Engagement Strategies to conduct outreach to increase uptake of these tools. (In process)
• CHCF’s Innovation Fund partnered with Get Well, a technology-enabled coordination platform, and CommonSpirit Health, the health system that delivers the most Medi-Cal births in California, to improve care for mothers / birthing people. Get Well’s platform pairs local, culturally responsive navigators with digital engagement tools to help mothers / birthing people navigate the health care system and get the care they need. Learn more about this project and the evaluation CHCF funded with the Center for Community Health and Evaluation. (2023)

A key tenet of CHCF’s birth equity work is centering the voices and experiences of Black birthing people.

• Entertainment 2 Affect Change (E2AC) is producing a documentary titled Deliver Us that highlights the journeys and historical racism experienced by Black midwives in the US serving Black birthing people. The documentary highlights Kim Durdin and Allegra Hill, Black midwives and co-owners of Kindred Space LA — the only Black-owned birth center in Los Angeles. (In process)
• Narrative Nation launched a national app called Irth (“birth without the bias”) to collect Black maternity care and birth experiences, with an emphasis on screening for bias and racism. CHCF funded testing and engagement in California. Irth is now partnering with three county public health departments to pilot a statewide, multiregional hospital quality improvement and patient safety project. (In process)
• Narrative Nation developed an inaugural podcast series in 2021 called Birthright to share joyful Black birth stories, with the goal of lifting up the positive for Black mothers / birthing people and their families, educating communities, and informing health care providers. Birthright has completed its second season, cofunded by CHCF and the Commonwealth Fund. (2022)
  • EVITARUS is assessing the impact of Birthright on current and potential listeners who are birthing people, nurses, physicians, and current medical students, as well as assessing the podcast’s potential value as a professional continuing education tool for health care providers and providers in training. (In process)
• For several years, CHCF funded Hollywood, Health & Society, a program of the University of Southern California’s Annenberg Norman Lear Center, to provide materials that help screenwriters more accurately depict maternity care on television and in other entertainment programming. A key topic of focus in this work was birth equity for Black mothers / birthing people. Stories such as one on The Resident help to educate the public. (2023)
• CHCF provided grants to the following community-based organizations that are rooted in Black communities and that collaborate with California’s health care system to improve maternity care: African American Breastfeeding Cultural Outreach Taskforce, Black Women for Wellness, iDREAM for Racial Health Equity, Kindred Space LA / Birthing People Foundation, and Roots of Labor Birth Collective. (2020)