The United States’ largely preventable maternal mortality crisis disproportionately affects Black and Indigenous communities. This health challenge is shaped by broader structural issues like racism, which influences access to quality health care, economic stability, and neighborhood conditions. Health-related social needs, like housing instability and food insecurity, directly contribute to poor maternal and infant health outcomes.
At a forum with stakeholders, including policymakers, funders, nonprofit organizations, and practitioners, we discussed strategies to improve maternal outcomes. One overarching takeaway is the importance of partnering with community and involving people with lived experience in every aspect of the work. Community-driven models are well-positioned to advance maternal health because they bring together various sectors; integrate community voices and equity through shared governance, resources, and vision; and apply strategies to drive lasting change. These models can build trust and reflect the unique voices and individual needs of communities. Specific recommendations include:
- Use personal stories and data to build the case for sustainable funding of local efforts. Stories and narratives highlight needs and opportunities for philanthropic and public funders to advance their commitments to community-driven efforts and improved maternal health outcomes through programmatic investments. Stories and data also serve as continuous feedback on the impact of these investments on the ground and how funding can be better targeted.
- Consider philanthropy a catalyzer, not just a stabilizer. When federal or state budgets are cut, public agencies and their grantees often look to philanthropy to step in and fill gaps. However, using philanthropy in this way constrains foundations’ ability to spur innovation and to prioritize operational and administrative support for community-based organizations that expands the network of funded grantees and broadens the reach of publicly funded services. Both public and philanthropic funders can also accelerate local efforts by implementing trust-based philanthropy principles or by reexamining and realigning funding strategies to emphasize greater transparency, mutual learning, and increased collaboration with grantees. Specific trust-based practices include providing flexible multiyear funding, simplifying and streamlining grant application and reporting requirements, and leveraging grantee feedback to inform funders’ strategies.
In addition, stakeholders had the following recommendations for the new administration:
- Leverage the Transforming Maternal Health model from the Centers for Medicare and Medicaid Services’ Innovation Center to drive changes in the maternal health landscape. Beginning in 2025, this 10-year payment and care-delivery model will be adopted by Medicaid agencies in 15 states. The model requires Medicaid coverage of doula services as well as increased access to midwives and birth centers and supports coverage of perinatal community health worker services. It incorporates lessons from various demonstrations, including Accountable Health Communities, notably the benefits of health-related social needs screening, referral, and navigation. The model also centers the involvement of community-based organizations and can be further enhanced through collaboration with federal partners like maternal mortality review committees, perinatal quality collaboratives, community health centers, Healthy Start grantees, and maternal, infant, and early childhood home visiting programs. This model will yield important learnings for Medicaid and other payer approaches in all states.
- Develop a more expansive national strategy to address maternal health. Stakeholders emphasized the importance of building on the previous administration’s Blueprint for Addressing the Maternal Health Crisis with a broader strategy that includes state, local, and private sector efforts and easily understood metrics. Nationwide efforts to address maternal health should include fathers and a focus on health-related social needs and the underlying drivers of health that affect maternal and infant health outcomes, including housing instability, food insecurity, transportation challenges, interpersonal violence, and socioeconomic status.
- Provide explicit guidance on doula reimbursement and maternal health alternative payment models. Medicaid is a critical payer of maternal health. It covers approximately 40 percent of all U.S. births and supports coverage of doula services, as well as other benefits that improve birth outcomes. However, there are barriers to receiving doula coverage that could be eased through adequate reimbursement and streamlined billing. A related recommendation is more widespread deployment of payment and care delivery models that provide reliable and quality care to families through a single payment for team-based and individualized perinatal care.
There is bipartisan interest in maternal and infant health at federal, state, and local levels. Even in an uncertain health policy landscape, continued and strengthened support for multisector community-driven partnerships is a promising and important part of the response to the maternal health crisis.
Acknowledgements
Founded in 2016, the Funders Forum on Accountable Health is housed within the George Washington University Milken Institute School of Public Health. The Forum is a group of philanthropic funders committed to collaborative national, state, and local efforts that advance multisector health-related partnerships centered in and accountable to communities, with the aim of creating equity-focused, transformed systems that support health, well-being, and thriving communities. Participating foundations include the Blue Cross and Blue Shield of North Carolina Foundation, Blue Shield of California Foundation, California Endowment, Commonwealth Fund, Episcopal Health Foundation, W.K. Kellogg Foundation, Kresge Foundation, and Robert Wood Johnson Foundation. Many of these foundations include maternal health and birth justice as well as children and youth well-being among their top strategic priorities, with their grantmaking supporting impactful work in these areas.
