HRiA Staff: Allyson Shifley, Mo Barbosa, and Victoria Nemeth
A MA Special Commission on Racial Inequities in Maternal Health report recognizes “Racism, not race, is a primary driver of the social determinants of health. It drives inequities in housing, income, and education, especially among communities of color.” Black birthing people are 1.9 times more likely to die during pregnancy or within one-year postpartum compared to white women in Massachusetts. The state has implemented several policies and programs to address the social determinants of health contributing to maternal mortality disparities. However, there are opportunities to reduce racial disparities at the local level across the state.
The Black Maternal Health Advocacy Project, funded by HRiA’s Innovation Incubator, focuses on maternal disparities at the local level. HRiA is collaborating with five communities in Massachusetts to design advocacy strategies that directly address Black maternal mortality and morbidity disparities. The goal is to close the critical gaps in local and municipal maternal health policies, ensuring community-driven solutions shape lasting changes.
Our Approach
The project team grounded its approach in two key frameworks. The Socioecological Framework ensured social, economic, and physical determinants and historical and contemporary injustices were evaluated in relation to Black maternal mortality and morbidity.
HRiA’s Health Equity Framework grounded the project’s approach in community engagement. This framework supports a community-driven and led approach. Centering lived experience and building local capacity shifts power and amplifies advocacy strategies aligned with community priorities.
Progress Thus Far
The team completed three key milestones: data synthesis, an environmental scan, and a policy scan. These milestones articulated:
- Where policy, systems, and environmental (PSE) changes should be prioritized. PSE change strategies are ways to make lasting, sustainable changes to support improved environments and behaviors in communities.
- What existing local-level PSE changes have been implemented in communities successfully.
- How to go about advocating for change in Massachusetts communities.
Using secondary data and community asset analyses, the team prioritized five communities: Boston (Mattapan), Brockton/Randolph, New Bedford/Fall River, Springfield, and Worcester. Communities were selected based on the priority population of Black birthing people and maternal/infant health outcomes.
An environmental scan revealed several organizations and individuals working to advance maternal health equity in each of the selected communities. The policy scan activities uncovered examples of local PSE changes, along with advocacy strategies that garnered support for a policy or allocation of resources for the sustainability of local public health initiatives. Examples of local PSE changes include:
- Policy: Rx Kids – A universal and unconditional prenatal and infant cash prescription program in which moms receive $1,500 during pregnancy, and babies receive $500/month for 6-12 months until age 1.
- Systems: Cradle Cincinnati Mama Certified – A project that collects, publishes, and shares maternal and infant health hospital data. The data helps parents make informed decisions on where to receive care, and the involved hospitals commit to creating action plans to improve care for Black birthing people.
- Environmental: Love for Latch – A program that partners with employers to create a more inclusive work environment that supports breastfeeding mothers in Boston.
These examples of best practices, strategies, and local policies will be shared with the five priority communities.
With foundational research complete, the team is now engaging directly with communities. They are building relationships with midwives, doctors, doulas, nurses, public health professionals, researchers, subject matter experts, community health workers, and coalition leaders to co-create solutions rooted in lived experience and expertise.
Next Steps
In November, the project team will launch a website featuring statewide and community-level maternal health data. Resources related to maternal health, advocacy, and a directory to connect individuals, organizations, and coalitions across Massachusetts will be included. In addition, the site will have an intake form for people to contribute initiatives, organizations, coalitions, or resources – fostering collaboration and learning.
As the work progresses, the team will meet with partners in each priority community. Together they will explore local maternal health efforts, identify barriers to policy change, and co-develop advocacy strategies rooted in community experience.