MCH Leads Health Equity Edition – In order to advance health equity for MCH populations, beginning January 2023, MCH Leads will feature trainees’ health equity-focused work. We look forward to highlighting trainees’ experiences supporting the health and well-being of vulnerable and underserved populations and communities. Also, their work assessing and addressing the underlying causes of health disparities–and their efforts to promote diversity, equity, and inclusion–ultimately improving MCH outcomes. In addition, we encourage trainees to reflect on how the MCH Leadership Competencies are applicable to their health equity-focused stories.
Alyana Almenar (she/her) recently obtained her Master of Public Health in the Maternal, Child, and Adolescent Health (MCAH) Program from the University of California, Berkeley (UC Berkeley) in May 2024. She was a trainee under UC Berkeley’s Center of Excellence in Maternal, Child, and Adolescent Health. She obtained her Bachelor of Science and Arts in Human Development and Family Sciences with a Social Inequality, Health, and Policy certificate from the University of Texas at Austin. Her educational background and her previous roles as an assistant preschool teacher and clinical assistant at a developmental disorder clinic influenced her desire to address health challenges faced by maternal and child populations. Her interests focus on ameliorating health disparities experienced by marginalized MCAH populations both domestically and globally. She is interested in understanding what interventions and programs are needed to target social determinants of health and increase access to quality health care and resources to achieve equitable maternal, child, and reproductive health outcomes. Connect with Alyana on LinkedIn!
An Overview of Sisterweb and the Champion Dyad Initiative
During the summer of 2023, I had the privilege of completing my practicum with SisterWeb San Francisco Community Doula Network. I worked as an Evaluations Intern under Alli Cuentos, Sisterweb’s Co-founder and Director of Evaluations. SisterWeb is a community doula organization that addresses pregnancy and birth-related healthcare inequities for Black birthing people in San Francisco by providing access to equitable doula care through their Kindred Birth Companions Program. SisterWeb serves some of the most vulnerable communities in San Francisco and works to target social determinants of health by providing their clients with needed resources, support, and doula care at no cost.
The project that I worked closely on was SisterWeb’s Champion Dyad Initiative (CDI). The CDI is a quality improvement initiative that is being implemented at five San Francisco hospital/clinical sites with labor and delivery units, including Sutter Health California Pacific Medical Center, University of California San Francisco (UCSF) Medical Center, Kaiser Permanente Medical Center, Zuckerberg San Francisco General Hospital and Trauma Center, and San Francisco Birth Center. The CDI fosters a collaborative partnership between SisterWeb staff and one to two “champions” (e.g., providers, nurses) at each clinical site to uplift community doulas as key members of care teams and to ensure that birthing people of color receive fair and equitable treatment throughout their pregnancies and during the birthing process.
In the United States, racial disparities in maternal health outcomes persist where Black women are three times more likely to die from pregnancy-related causes as compared to their white counterparts (1). These disparities can be attributed to many factors including systemic racism and implicit bias, where Black women may experience discrimination, mistreatment, and lower quality of care in clinical settings. Studies have found doula support to be associated with higher levels of respectful care, especially among lower-income, racial, and ethnic minority groups who are most vulnerable to poor health outcomes (2).
SisterWeb’s CDI program works as a quality improvement and accountability tool by forming partnerships with CDI champions who are committed to antiracist practice, passionate about collaborating with doulas, and have positional power to advocate for changes within their clinical sites. The CDI partnerships provide opportunities for bi-directional feedback with doulas and providers, establish a referral process, allow for doulas to advocate for their patients, hold providers accountable, and facilitate culturally congruent care.
My Practicum Experience
Working as an evaluations intern, I had the opportunity to engage with the CDI in multiple ways. The first was through evaluating CDI-specific data metrics and helping create a video presentation that was shown at the 2023 National Maternal Health Innovation Symposium. The presentation provides an overview of the CDI and presents quantitative data such as instances of care coordination, average levels of respect from clinical staff as reported by doulas, and average levels of support from doulas and providers as reported by clients, as well as powerful qualitative data that highlights the impact that collaboration between doulas and providers has on improved client care.
I also assisted with the submission and designation of the CDI as an Emerging Practice in the Association of Maternal and Child Health Programs (AMCHP) Innovation Hub. For this designation, I created SisterWeb’s CDI implementation handout for the Innovation Hub database, providing a summary, lessons learned, and next steps. This highlights the CDI as an innovation that is effective in positively impacting maternal and child health (MCH) populations and can be adopted and implemented by other organizations to move towards health equity on a broader scale.
Throughout my internship and working with my preceptor Alli, we often discussed what can be done to improve the CDI and advance health equity. One of the next steps that was identified was the creation of a CDI Incident Accountability Tracker. The goal of this tracker was to be able to take actionable steps surrounding reported feedback of issues at sites or negative incidents experienced by clients and doulas during appointments or labor/delivery. The tracker provides an opportunity to describe incidents and follow the progression of discussing the incidents with sites to find a resolution. The tracker allows SisterWeb to hold sites accountable for issues related to discrimination and mistreatment and works toward more equitable outcomes for birthing people of color.
I ended my practicum with the opportunity to virtually meet and discuss with providers/champions from each site. During these meetings, I was able to highlight SisterWeb’s accomplishments with the CDI, particularly in its designation as an Emerging Practice in the AMCHP Innovation Hub, was able to introduce the implementation of the CDI Accountability Tracker, and was able to get feedback on how SisterWeb can further improve the CDI feedback form and referral processes. In meeting with each site, I got to experience firsthand how engaged and dedicated both SisterWeb staff and the site champions were in improving the CDI program to provide more respectful care for the doulas and the clients/patients.
What I Learned: Role of Doula Care in Health Equity
My practicum with SisterWeb was a fulfilling experience. I truly felt the work I completed with SisterWeb, and in particular, the CDI, contributed to advancing health equity. Throughout my time working with them, I was able to see and feel the deep commitment that the whole organization had to dismantling systemic racism and addressing inequities in maternal health.
There are a few main takeaways that showed SisterWeb’s commitment to health equity. First, the commitment could be seen in the time that SisterWeb doulas put into providing their clients with the emotional, physical, and educational support they may need to navigate their pregnancies and the healthcare system. Second, the commitment could be seen in SisterWeb’s leadership team’s dedication to running a community doula organization, uplifting their doulas as essential birth workers, and providing them with the professional development and skills needed to establish doula care as a professional career. Third, the commitment could be seen in the collaboration through the CDI, which revealed the impact that partnerships and consistent communication have on improving outcomes. Lastly, in working closely with the data and metrics, SisterWeb’s commitment could be seen in the performance indicators highlighting that the work that SisterWeb does is effective for quality improvement and addressing inequities.
Ultimately, my time at SisterWeb revealed how important access to doula care is for birthing people of color. Culturally congruent community doulas can play a vital role in ensuring that patients feel supported in all aspects of their pregnancy journey, ensuring that patients are knowledgeable about their options and are receiving culturally congruent care in clinical care settings, and ensuring that hospitals are held accountable to provide equitable, quality care to their patients of color. It is key that community doula organizations, like SisterWeb, are provided with consistent funding and resources to continue their important work in advancing health equity for maternal health populations.
References
- Centers for Disease Control and Prevention. Working Together to Reduce Black Maternal Mortality. Published April 8, 2024. Accessed April 25, 2024. https://www.cdc.gov/healthequity/features/maternal-mortality/index.html
- Mallick LM, Thoma ME, Shenassa ED. The role of doulas in respectful care for communities of color and Medicaid recipients. Birth. 2022;49(4):823-832. doi:10.1111/birt.12655
