“‘If you want to go fast, go alone. If you want to go far, go together.’
This is a lot of work, and we are just the tip of the iceberg.”
—Danielle Little, Maternal and Child Health Consultant
and MCHEAN Facilitator, quoting an African proverb
Across the United States, maternal mortality increased 58 percent from 1990 to 2017. This rate is estimated to have continued rising since 2017, making America the only industrialized nation with increasing maternal mortality.
There is also a maternal and infant mortality equity crisis happening in North Carolina and throughout the country. In our state, Black women are four times more likely to lose a child before their first birthday compared with white women and 2.9 times more likely than white women to die while pregnant or within a year of childbirth.
Everyone deserves access to equitable, compassionate, culturally attuned, high-quality health care. Yet, that is far from the current reality. Black women and birthing people and babies are disproportionately affected by mortality and morbidity. These health disparities are connected to social, economic, and environmental factors, such as structural racism and other social drivers of health (SDOH).
Despite decades of dedicated effort, North Carolina still has the eighth-highest infant mortality rate in the nation. The Maternal and Child Health Equity Action Network (MCHEAN) aims to turn conversations into actions that strengthen maternal and child health equity in North Carolina.
As MCHEAN reached the one-year mark, we sat down with Danielle Little, a Maternal and Child Health Consultant and MCHEAN Facilitator, to learn more about her experience and the network.
Danielle Little: Maternal & Child Health Educator, Advocate, & Co-Facilitator
Danielle has been advocating for maternal and child health for years. Her expertise spans pregnancy and postpartum care, childbirth education, and infant and early childhood work. The first time she remembers advocating for birth was while sharing her birth story in class at the women’s university she attended: “I shared my story, and I said it’s a matter of advocating for yourself and knowing your body, trusting your body.”
The professor who taught that class told Danielle about an internship opportunity at a local hospital that launched her career in maternal and child health work. She then became a childbirth educator, expanded her skills and knowledge, and continued advocating for maternal and child health.
Expansion of Maternal Health & Childbirth Education
Danielle has seen many changes since she began working in maternal health and childbirth education. “When I started to do the work in childbirth education, no one looked like me. They were older white women, more than likely retired. They had been doing the work for quite some time,” she said.
Then, she told us, the field of maternal and child health took off:
“It kind of caught like wildfire, to be honest with you. This was just something that affluent white women were able to afford—that ancillary care outside of your OB (obstetrician) care or your pediatric care, care and support at home, and postpartum doula support. That was something that wasn’t very prevalent in the African American population. Now, in duty itself, it was present between grandma, mom, family members, and things like that. But to have community members and family members that had been updated on the new research and approach to supporting women who were giving birth or birthing people who were giving birth, that didn’t exist.”
MCHEAN Membership & Lived Experience
MCHEAN is an example of this fire catching on. Danielle told us the statewide network includes everyone from those working “boots on the ground” to policymakers and many other individuals passionate about maternal-child health.
The network recognized the need for diverse perspectives and a range of lived experiences to engage in the conversation, including those receiving, providing, and/or observing care. “While we are cognizant of the importance of those with lived experience as direct recipients of care, we also want to hear the experience of those who are providing care, those who are observing care as well, because sometimes those voices and interactions are so important,” she said. “They disrupt the perpetuation of inequitable care, and what that would look like in certain spaces can be explored.”
For Danielle, it is critical to remember that MCHEAN members are also the communities they seek to support. “We are the community we serve,” she said. “We ask folks to bring that [experience] to the table, your work, your advocacy, your approach, your energy, your passion, and then step back and also explore your individual experience with maternal-child health, either as a father, as a partner, as a mom, a grandparent.”
Milestones & Achievements
“The network engaged over 50 statewide members and hosted focus groups where over 84 community members shared their experiences, ideas, and insights.”
—Alexandra Simpson, MCHEAN Facilitator
April 2024 marks MCHEAN’s first anniversary, and Alexandra Simpson, another MCHEAN co-facilitator, shared some key milestones and achievements. She told us, “The facilitators range from YMCA leaders to ECU students, and they came together to help facilitate the focus groups,” Alexandra said. “Being that the charge was to have to recruit and onboard at least 40 network members with 25% lived experience representation, we met and exceeded that goal, which was great.”
From April 2023 until February 2024, the network met monthly for an hour and a half. Once these listening sessions ended, the co-facilitators collaborated to compile the work to present it to the network. They sought and incorporated feedback by contacting network members and attending taskforce and stakeholder meetings to gather further input for the action plans from community members and state leaders.
Danielle described the “call-and-response” feedback process they used in the monthly meetings and action-plan development, “Is this what we heard? Did we hear you? Is this what you were saying? We wanted them to validate what we were pulling together.”
During the stakeholder review, the co-facilitators thanked all the network members for their time and insights. “One participant said, ‘Well, thank you for asking.’ And that has sat with me,” Danielle said. “It sounds like the people who are on the frontline aren’t the ones being asked about the work. Yes, we are asking recipients of care, and we should continue, but there’s another sector that we’re missing to continue those conversations.”
Along with emphasizing the need for including more people in these conversations and efforts, she highlighted the connections between the experiences of folks working in health care settings and the care provided there:
“I want to know how the least of those in the space is being treated. That is an indicator for me of the personality and the quality of the entire experience. If the janitor at the OB/GYN (obstetrics and gynecology) office isn’t treated well, that, to me, speaks volumes about how the practice itself would treat anybody.”
Focus Groups & Action Plan Best Practices
The MCHEAN co-facilitators applied a human-centered design approach, the cornerstone of FHLI’s Community Voice Model, to lead focus groups in 2023. Danielle said the meetings felt like a case review, “Because the network was so diverse, when someone was sharing their story of lived experience, we could say, when did this happen? That sounded like that was a missed opportunity based on standard of care.”
Many of the strategies in the MCHEAN action plans came from identifying gaps in care delivery and breakdowns in communication through story sharing, she told us.
Challenges & Opportunities to Advance Maternal & Child Health Equity
We asked Danielle about the challenges and opportunities she sees moving forward. She emphasized the need for more voices in the conversation, more buy-in, more accountability, and more system-wide action to improve health outcomes.
She said, “I always showcase this African Proverb, and it says, ‘If you want to go fast, go alone. If you want to go far, go together.’ This is a lot of work, and we are just the tip of the iceberg. It is intricate as far as systemic racism and inequity, and it’s just a hub of all the things that we advocate against and advocate for.”
Alexandra Simpson, an MCHEAN co-facilitator shared her thoughts on opportunities for advancing maternal and child health equity:
- Uplift community organizations doing great maternal and child health work that need more funding and infrastructure.
- Partner with health care systems to see if they will buy in on strategies to improve health outcomes for birthing people of North Carolina.
- Facilitate the development and implementation of the network action items to see them brought to fruition.
- Continue to support those who are doing the work and doing it well.
She also noted, “There is an opportunity for capacity-building amongst organizations who are doing the work, who may not have the infrastructure, and capacity-building or compassion-building for those who have the funding, who are not necessarily boots on the ground.”
As of early 2024, the network has completed the co-designed action plans. Danielle hopes to keep the momentum going to improve health equity for families and children. “We want to continue to engage the network and showcase the work that’s being done and the trickledown effect and impact,” she said.
Moving forward, Danielle hopes to see a continued focus on infrastructure and capacity-building efforts. She sees an opportunity to address challenges through more equitable grant applications and funding disbursement, paired with concrete efforts to create more accountability at all levels of health care.
Along with that, Danielle told us that to create truly equitable systems, everyone involved in health care must be held accountable for the health outcomes we see. Although efforts to increase workforce diversity and training should continue, more needs to be done.
“We hold health care providers responsible for harm that they’ve inflicted to an extent, whether it be implicit or not. But there’s two levels of health care, it’s the business of health care and it’s the health care providers.”
FHLI’s newest program, the Roadmap to Innovation, is scheduled to launch later this year in western North Carolina. It will focus on behavioral health and the maternal and child health work driven by MCHEAN members and facilitators.
Resources & Related Content
- America Dissected public health podcast episode: Getting Practical About Saving Black Moms and Babies
- The Practical Playbook III: Working Together to Improve Maternal Health, a guide (co-edited by FHLI Board Chair Dr. Lloyd Michener) for researchers, community activists, and advocates with strategies to improve inequities in maternal health
- FHLI Landscape Analysis Report: Progress and Opportunities Maternal and Child Health Equity in North Carolina
Definitions
- Maternal Mortality: Deaths due to complications from pregnancy or childbirth
- Maternal Morbidity: Any health condition attributed to and/or complicating pregnancy, and childbirth that harms the woman’s well-being and/or functioning
- Perinatal: Period when you become pregnant and up to a year after birth
- Prenatal: The period before birth; during or relating to pregnancy
- Postpartum: The period following childbirth