We all want safe, uplifting, and meaningful pregnancies and delivery experiences for birthing people. Unfortunately, systems and structures constructed in our country have led to birth inequities resulting in higher maternal and infant morbidity and mortality, particularly for pregnant people and infants of color.
Recently, researchers representing teams funded by Evidence for Action, Policies for Action, and Systems for Action joined Andrea Serano with Reaching Our Sisters Everywhere to discuss their experiences conducting research to advance the health and wellbeing of birthing people and their babies.
Research Questions
Given the number of contextual factors that impact the experiences, health, and wellbeing of pregnant people, grantees from the 4Action research programs are exploring many different facets of the pre-, peri-, and post-pregnancy experience. Research questions from each project include, but are not limited to,
- What elements of a Pop-up Village (PV) model of perinatal care are essential for it to be valuable to recipients? What key factors of the PV partnership process and model for care delivery impact experience and sustainability from the perspective of PV providers? Does the PV model reduce barriers to accessing health and social services, increase person-centered care, reduce experiences of discrimination while accessing care, and/or improve the mental well-being of participants?
- Which local policy solutions in New Jersey help ensure safe, healthy pregnancies and births, such as local laws and regulations around zoning, transportation, housing, public safety, and social and health services?
- How effective are multi-sector financing and delivery strategies in expanding the reach and impact of the Nurse-Family Partnership program across the United States?
Possible Approaches
Each of the speakers described rigorous research approaches and methodologies being employed in their studies, and there were consistent messages about beneficial practices for teams studying interventions occurring in the “real world.” One emerging theme from the discussion was how engagement with community members, organizations, governing bodies, and other entities enhances the development, implementation, and dissemination of research. For example, engagement with these groups ensures that the research is answering questions being asked by the community and relevant decision-makers, opens doors to new partnerships and avenues of dissemination, creates opportunities to receive real-time feedback that can be implemented to increase effectiveness and sustainability of interventions.
Community & Cross-Sectoral Engagement
According to the speakers, engaging with community members and organizations is best done by meeting people where they are (i.e., community gatherings). As Dr. Nijagal and Dr. Williams highlighted, taking conversations outside of institutional settings can help people feel safe and comfortable and shift power dynamics so individuals feel like they are on more of an equal footing.
Closely related to this, Dr. Williams spoke to the importance of speaking plainly about the research and sharing findings with the community along the way, rather than waiting until after the peer-reviewed publication process. Dr. Muchomba also shared that attending community gatherings led to conversations with birth equity advocates and other beneficial, although unforeseen, outcomes. For instance, he connected with a New Jersey disc jockey who was keyed into the importance of birth equity by his wife, who happens to be a doula. This connection resulted in on-air discussions in which Dr. Muchomba was able to share his learnings with new audiences.
Building & Maintaining Relationships
Closely related to the above, all of the speakers discussed the importance of building and maintaining cross-sectoral and community partnerships. As Dr. Nijagal shared, the maintenance of community partnerships is more challenging than she anticipated based on her experiences forming a professional network, as it can be very time and resource intensive.
As all of the speakers discussed, building and maintaining relationships requires building trust. For those working out of large research institutions, this can mean overcoming understandable distrust resulting from years of harm done in communities caused and perpetuated by these institutions. There are many different approaches to this, but as Dr. Muchomba so aptly put it when answering a question about how to acknowledge past harms, “I just want to say that it's easy to just give empty words, and words can often be hollow. The way I see it, acknowledgment of harm really means that we are doing something about it.”
The speakers shared different ways to do this, including using professional status to drive institutional change, fundraising for community organizations, and providing direct resources to communities and advocates. Dr. Williams highlighted that this support can also come at an individual level, “working with my project managers, my research assistants, and the community…in achieving their goals with whatever means and tools I have to get them there. That's what I'll do.”
Putting Evidence Into Practice
All of the speakers are committed to conducting research that will create lasting, positive change in the community. This requires evaluating often overlooked policies that have a large impact, local- and organizational-level policies. As demonstrated by Dr. Muchomba’s work, the ways in which cities allocate their budgets has a large impact on severe maternal mortality (SSM). Municipalities allocating larger portions of available financial resources to housing, transportation, education, and other social support services have lower SSM. Dr. Muchomba also shared that if you want to impact policy and budgetary decisions, you need to start building relationships with decision-makers early on to understand how the budget is developed and share any insights before it is finalized. By the time the budget becomes public, it is far too late to influence changes to advance health, wellbeing, and equity. Dr. Williams also highlighted the need to demonstrate effectiveness of home nursing programs, specifically, to ensure continued government support and funding.
Dr. Nijagal spoke about the actionability that can come from building relationships with community members and organizations. The unique and strong relationships with two doula organizations in San Francisco meant that they were present at all of the pop-up village events. At these events, they learned that there were no longer any free birth classes being offered in the city. “So we decided that Pop-Up Village is the perfect place to offer and support that service. And so one of our doula organizations is really taking that on as the organizing entity to ensure that there always is a birth instructor there.”
This blog highlights only a small portion of the incredible insights and learnings shared by Drs. Nijagal, Muchomba, and Williams. Learn more by accessing the full webinar recording.