Birth Equity – California Health Care Foundation

• The National Birth Equity Collective (NBEC) is partnering 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 NBEC and NCQA partnership is cofunded by the Pritzker Children’s Initiative, Robert Wood Johnson Foundation, and W.K. Kellogg Foundation. (In process)
• Center for Health Equity at the University of California, San Francisco (UCSF) will be conducting the Maternal and Infant Health Assessment (MIHA) focused on respectful maternity care (RMC). MIHA is an annual, statewide-representative survey of women with a recent live birth in California. MIHA is a collaborative effort of the Maternal, Child, and Adolescent Health (MCAH) and Women, Infant, and Children (WIC) divisions of the California Department of Public Health (CDPH) and the Center for Health Equity at UCSF. The MIHA project is supported by CDPH using federal funds from the Title V Maternal and Child Health Block Grant and the Special Supplemental Nutrition Program for Women, Infants, and Children. (In process)
• Black Women for Wellness (BWW) 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 CHCF Almanac report Maternity Care in California describes the state of maternity care in California, including available statewide data that highlight disparities in maternity care and maternal outcomes. (2019, with new edition expected fall 2023)
• The California Maternal Quality Care Collaborative (CMQCC) has 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)

Doulas

• RACE 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.
• 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 is conducting 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)
• The National Health Law Program (NHeLP) conducted focus groups to better understand the on-the-ground issues (e.g., scope of practice, training and certification, reimbursement) impacting doulas who provide care in California. NHeLP 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 in the publication Lessons Learned from California’s Doula Pilot Programs. (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 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 (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 Healthforce Center at UCSF are surveying 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. (In process)
• 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

• NBEC is currently working on a Perinatal Workforce Education Project, which will include a digital e-book on the different types of perinatal health care professions within the maternity care workforce (clinical and nonclinical) that provide medical care and support to birthing people before, during, and after birth. The anticipated project launch date is summer 2023. (In process)
• The Urban Institute is conducting 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. (In process)
• The California Black Women’s Health Project provided training and support to Black birth workers who supported Black mothers / birthing people during 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)

• CHCF is funding learning and evaluation of several prenatal and postpartum programs:
  • Two that are expressly Black-centered
  • One that supports underresourced communities
• 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 SB 464 that requires hospitals to train their maternity care staff about implicit bias. The first set of modules were developed with stakeholder input. (2021)
  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)

• 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, who are Black midwives and co-owners of Kindred Space LA — the only Black-owned birth center in Los Angeles. (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 is now in its second season, cofunded by CHCF and the Commonwealth Fund. (In process)
• Narrative Nation launched a national platform 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.
• CHCF is funding Hollywood, Health & Society, a program of the USC Annenberg Norman Lear Center, to help screenwriters more accurately depict maternity care on television. A key topic of focus in this work is birth equity for Black mothers / birthing people. Stories such as this one on The Resident help to educate the public. (In process)
• CHCF provided grants to the following community-based organizations that are rooted in Black communities and 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)