Closing the Maternal Health Gap with Homeland Heart

Pregnant woman of color laying on couch holding her belly

Doula and founder of Homeland Heart, Kristin Mejia-Greene, noticed a healthcare void when it came to Black expectant mothers. After she welcomed her firstborn in 2014, she quickly discovered that Black women and white women often have very different birthing experiences. Seeing the stark inequity in these two populations, she learned all she could about Black maternal mortality and morbidity rates. Her findings were shocking. As she investigated further, she learned from the Centers for Disease Control and Prevention that, “The risk of pregnancy-related deaths for Black women is three to four times higher than those of white women.” After learning about the maternal health gap and training as a doula in 2016, she decided to create Homeland Heart & Wellness Collective, a community-funded initiative that solely serves women of color.

We talked to Mejia-Greene about maternal health and mortality, how doulas can prove a powerful advocate within care teams, and how her organization Homeland Heart is working to provide better care for Black mothers in Nashville. Watch the conversation here or keep reading for a summarized version.

What is Homeland Heart, and who does it serve?

Homeland Heart provides free doula services to Black families in the seven zip codes of Davidson County, TN, that are experiencing higher than or equal to the U.S. national average Black infant mortality rate. Mejia-Greene and Homeland Heart work to better serve Black families on the frontend by ensuring that Black expectant mothers have the proper education and care they need in their prenatal journey. This help inadvertently translates to better bonding and devotion to their children, producing a reduction in Black maternal disparity or loss. Mejia-Greene says, “If we take better care of Black women on the frontend, there’s a greater survival rate for both mothers and babies, increased attachment and bonding, and a higher likelihood that the Black infant will make it to his/her first birthday and beyond.”

How do we systematically close the maternal health gap?

“To best care and serve your community, you have to actually involve the community,” says Mejia-Greene. She speaks specifically about how vital it is for healthcare organizations to have relationships with community partners like Homeland Heart, who are doing the work to establish safe spaces and relationships with Black women.

Although Mejia-Greene notes that she does see progress in hospitals mandating implicit bias training, she says, “It’s simply not enough to just talk someone through their implicit bias. There should be an extra push for health disparities training. Providers, particularly in the maternal health fields, should confront the disparities head-on.” This training type would show the staff how their implicit bias contributes to the disparities in communities of color and how they can fix their behaviors. “People don’t see how they’re driving the disparities that we see.”

Whole-person maternal care starts long before the due date.

When should providers recognize the risk to Black mothers? Mejia-Greene admits that this answer might surprise many. She says that ideally, it would be around 9-10 years old.

Unfortunately, young girls often aren’t educated on what their body is capable of. Mejia-Greene says, “We’ve worked with teenage moms who didn’t realize that their period stopping meant that they were pregnant. If we weren’t so afraid that teaching children about sex led to them having it, we actually might have fewer children having sex and less children having children.”

When you’re pregnant, a doctor will explain what your body is going through at the time of your appointment. Doulas describe what’s going on with your body through every stage of your pregnancy, helping with co-management and continuing care between prenatal visits and postpartum visits. Community-based doulas have experience in the same community as the woman she is serving and is knowledgeable in local resources, referrals, and care.

How do we better equip our communities to invest in social determinants of health?

Although state doula pilot programs are already running in New York, Minnesota, and Oregon, Tennessee is, sadly, not one of them. Furthermore, since Homeland Heart is exclusively for Black women, it doesn’t qualify for state funding. She says, “It’s the whiteness of the world that expects me to save my community without reward. As a Black woman, I know I have what it takes to work with Black women and turn this around. I also know that I’m going to have to do this for free. If someone was willing to pay me to do it, it would already be done.”

According to the U.S. National Library of Medicine, “Appropriately reimbursing, funding training and certification of a diversity of women to serve as, and expanding the role of doulas will improve outcomes, particularly for high-risk women.” Not only is this a more cost-effective solution, but it reduces disparities for better care and more favorable outcomes for maternal health.

As a push for healthcare for change, it’s essential to have payers, providers, and patients in conversations just like this one. While Mejia-Greene is doing what she can, with limited resources, for community members in dire need, there’s much more that needs to be done. Until that time comes, Mejia-Greene will continue to fight for closing the maternal health gap for women of color. As she puts it, “These are our sisters, and we’re not going to let them perish.”

To learn more about Homeland Heart check out their website. 

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