perinatal support program

The problem

A persistent and preventable disparity

In 2013, Ohio ranked 45th among the 50 states for infant mortality, with an overall rate of 7.33 infant deaths per 1,000 live births. But the statewide numbers obscured an even more troubling disparity: Black infants were dying at nearly twice the overall state rate.Ohio's Black infant mortality rate was 13.8 deaths per 1,000 live births in 2013, increasing to 14.3 in 2014.The disparity was reflected locally.In 2013, Cuyahoga County recorded an overall infant mortality rate of 8.9 deaths per 1,000 live births, compared with Ohio's rate of approximately 7.4 and a national rate of approximately 6.0. Cleveland's citywide infant mortality rate was 12.9 for the 2012–2015 period.For Black infants in Cuyahoga County, the numbers were even more alarming: 14.7 deaths per 1,000 live births in 2013 and 14.4 in 2014.These figures revealed a persistent and deeply troubling disparity in birth outcomes. Black infants were experiencing substantially higher mortality rates, both statewide and within the Cleveland community.This was the public health challenge confronting the community in 2013–2014: How do we change the conditions contributing to the disproportionate loss of Black infant lives?It was against this backdrop that the Cleveland Foundation began exploring opportunities to address infant mortality and lead poisoning in Cleveland. I was invited to present an idea for addressing Black infant mortality.That invitation would become the starting point for an intervention designed to do more than respond to the immediate problem.

THE INQUIRY

Where was the village?
Where was the sisterhood?

The numbers established the urgency of the problem. But changing the numbers would require looking beyond the numbers themselves.I began examining the support surrounding Black women throughout the perinatal experience. What became apparent was that while programs existed to address various aspects of maternal and infant health, there was a critical dimension missing from the response: the social and relational infrastructure surrounding women.Where was the village? Where was the sisterhood?Women needed more than referrals, appointments, and periodic home visits. They needed community. They needed relationships with other women, opportunities to share experiences, and people who could walk alongside them through pregnancy, childbirth, and postpartum.The gaps I identified included:

Home-visiting programs and other maternal health initiatives were already operating in the community. But providing services to an individual woman was not the same as building a community of support around her.I saw an opportunity to approach the problem differently.Rather than simply adding another service to an existing collection of programs, what if we designed an interconnected system of support that could surround women throughout their perinatal journey?What would it take to rebuild the village around birth?That became the central question guiding the intervention design.

THE INTERVENTION

The Perinatal support pipeline

I designed an 80-week Perinatal Support Pipeline: a comprehensive, community-based model that connected women to education, relationships, birth support, and resources across the perinatal experience.Rather than treating pregnancy, childbirth, and postpartum as separate events, the pipeline approached them as interconnected stages in a woman's life journey.The model created opportunities for sustained engagement through two to three classes and activities each week, combining childbirth education, sister circles, birth support, postpartum support, and access to resources.But the intervention extended beyond the delivery of services.I also designed a broader framework for addressing the conditions surrounding women's lives.

IMPLEMENTATION

From idea to operating model

The first investment was a $4,300 grant to conduct four community events focused on pregnant women and birth. Building on that initial work, the Cleveland Foundation awarded $125,000 to pilot the Perinatal Support Program.In 2015, I established Birthing Beautiful Communities as the organizational vehicle for implementing the intervention.Launching the programI partnered with Neighborhood Connections to secure training space and brought trainers from Mamatoto Village in Washington, D.C., to prepare an initial cohort of approximately ten women as Perinatal Support Persons.Operationalizing the pipelineThe program was structured around two to three classes and activities each week, incorporating childbirth education, sister circles, and ongoing perinatal support.Practical supports were also built into program delivery. Transportation assistance through Uber helped women get to classes, medical appointments, and other essential destinations. Food and childcare were provided during program activities to make participation more accessible.Through these partnerships, resources, training, and operating structures, the Perinatal Support Pipeline moved from an intervention design into an active community-based program.

RESULTS

What happened when the village was rebuilt?

The Perinatal Support Program produced measurable birth outcomes, documented participant experiences, and generated opportunities for further research into the experiences of Black women during pregnancy.

An independent external evaluation examined 119 births among program participants between January 2017 and June 2018.

LEGACY

Reimagining what birth equity requires

The Perinatal Support Program began with a question about why Black babies were dying. It evolved into a broader approach to addressing the conditions surrounding Black women's lives and the support structures necessary for women and families to thrive.The work introduced a community-based perinatal support model, developed a trained workforce of Perinatal Support Persons, and connected birth equity to six areas of women's lives through the Holistic Birth Equity Model.But its contributions extended beyond program implementation. The experiences of participating women became the subject of academic research, while separate investigations into stress among Black pregnant women opened new questions about the relationship between socioeconomic conditions, lived experiences, and birth outcomes.The work also reinforced a central premise that continues to inform my approach to intervention design: outcomes do not exist independently of the conditions that produce them.If we want different outcomes, we have to examine and change the conditions producing them.The village was not simply a metaphor. It was an intervention design challenge.And the Perinatal Support Pipeline was one expression of what becomes possible when we approach that challenge through intentional design.

RESEARCH & PUBLICATIONS

Contributing to the body of knowledge on birth equity

The Perinatal Support Program generated questions and insights that extended beyond program implementation. The experiences of participating women became the subject of academic research, resulting in at least four peer-reviewed journal articles to which I contributed as an author.These publications examine the experiences of Black women receiving perinatal support and contribute to a broader understanding of community-based approaches to maternal health, birth equity, and the role of support throughout the perinatal experience.This research represents another dimension of the work: not only designing and implementing an intervention, but documenting its experiences, examining its implications, and contributing to the knowledge that can inform future approaches to improving birth outcomes.