Study shows Mamatoto Village’s culturally relevant care can improve birth outcomes for Black people

In May 2017, Deette Henry was rounding out her first trimester of pregnancy. She was also facing homelessness, depression, and anxiety about having a baby.

“I was scared to be pregnant. Not knowing if I was going to be a good mom. I didn't want to be like my mom or mothers — I'm adopted and I didn't really have a good childhood,” says Henry, who’s now a mom of two boys. During one of her appointments at Community of Hope in Southwest, someone suggested she visit Mamatoto Village, a community-based perinatal care hub based in Deanwood. 

“I was struggling with food, struggling with not having family support. I went through lashouts, mental health moments. I got evicted from my place. I was at a turning point. I needed some guidance,” she says. 

Henry enrolled in the organization’s Mothers Rising Home Visiting Program, which provides individualized and culturally relevant care to Black moms in D.C. who qualify for Medicaid. It includes a host of service providers such as doulas, birth workers, and lactation specialists who literally meet mothers where they are as they prepare for birth and navigate motherhood. 

Black people made up half of all births in D.C. but accounted for 90 percent of pregnancy-related deaths between 2014 to 2018, according to the city’s Maternal Mortality Review Committee. During the same period, white people constituted 30 percent of births but did not experience a single maternal death. When it comes to infant mortality in the District, there are similar disparities.

Home visiting programs aim to ameliorate these outcomes by improving maternal care provision while preventing injuries, child abuse, and neglect. Research shows they can increase the likelihood that expectant moms will receive care by reducing or eliminating the need for transportation and childcare.

Their successes – and increasing recognition of the problem – have contributed to an increase in funding in recent years, with the Biden Administration dedicating $440 million to fund home visiting across the country last year, and D.C. receiving $2.5 million in federal funds for such programming — a 33 percent increase from the previous year. 

In 2024, the D.C. Council also passed the Home Visiting Services Reimbursement Act of 2024, which extends health insurance coverage for eligible home visiting services through Medicaid, DC HealthCare Alliance, and the Immigrant Children's Program. “Home visitors deliver critical early intervention support, including education and coaching, to expecting parents and families with young children with the goal of improving their health outcomes,” says At-Large Councilmember Christina Henderson, an advocate for maternal health on the D.C. Council. 

Mothers Rising started in 2016 and is one of 17 home visiting programs in the District. It deploys a holistic model of care that engages culture, community, and extended family networks to improve birth outcomes. 

“There is a need for hyper-local, culturally-tailored interventions to address disparities in Black maternal and infant health outcomes,” Aza Nedhari, Executive Director, Co-Founder of Mamatoto tells The 51st. “More than anything, I think that the impact of the program really does show the necessity in addressing social needs as a component of maternal health outcomes improvement.”

A central strategy for achieving these goals is their training program, where women who are from the communities where they’ll work (many of them former program participants) study to become perinatal community health workers. The training is grounded in reproductive and birth justice and takes over 160 hours. For the almost 200 Black participants, it’s the first step to a sustainable career in a growing field. It’s also building a perinatal workforce with an intimate understanding of the cultural dynamics, neighborhoods, and families of the women and children most at risk.

“The workforce development piece is key and integral,” says Erin Snowden, Director of Data & Social Impact at Mamatoto Village. “It is a very rigorous training, and we like to say that it goes beyond just a typical doula training — women are being trained to give that labor support. These women become the community experts in perinatal health. They become the community experts in Black maternal health. It’s not just about having someone there with you during your labor and delivery. It's all of the social aspects, psychological aspects, that happen prior to during and after the birthing experience.”

The organization collaborated with Georgetown University last year to conduct a formal evaluation of this work. The study compared the perinatal outcomes of Mothers Rising participants and other Black pregnant women in D.C. who were not part of the program. Out of the small sample of 100 participants in the study, Mothers Rising participants had a higher gestational age (babies born closer to the recommended 39-40 weeks). Babies born before 37 weeks are considered premature and are susceptible to life-threatening infections and illnesses. 

“There were some positive trends in other areas, like birth weight and reduction in preterm birth, but those were not specifically significant, and so we will be repeating the evaluation of them,” says Nedhari, highlighting the importance of measuring efficacy.

In the decade that Mamatoto has been in existence, they have also advocated for changes in systemic racism that contribute to negative health outcomes for Black women. This includes a lifetime exposure to higher stress levels which can contribute to preterm birth and perinatal healthcare providers who often ignore or dismiss the pain levels of Black patients, risking missing early warning signs.

Nedhari says that the new data helps strengthen their case for birth equity and reproductive justice. “The broader implications of what we gather from this is shifting that focus away from race to racism. We need to stop focusing on ‘this is happening because you are a Black woman.’ It's not because you're Black, right? It’s the systems that Black women are having to navigate while they are pregnant,” she says. 

Henry’s journey through Mothers Rising was like that of all qualifying participants. During the intake, she worked with one of the programs’ trained Perinatal Health Care Workers to complete an in-depth psychosocial assessment, which is used to create a customized plan that service providers implement for approximately 30 weeks.

This plan takes into account the unique personal circumstances and social stressors of each participant. For Henry, this was grieving the loss of her grandmother, who she was living with, while negotiating the economic struggles of living in one of the most expensive cities in the country. 

“I was very emotional. I went through a lot of depression. It was very overwhelming,” she says. 

To implement the plan, health workers collaborate with other providers to offer holistic postpartum care, parenting education, lactation anticipatory guidance, mental and physical health consultations, and planning for life after birth. 

“Mamatoto always made it easy. They came as support. They came with me to every doctor’s appointment. They helped me with my documents [for housing], like anything that was needed. They were like mentors and sisters to me. They just helped me a lot,” Henry says. 

After the birth of her son in October 2017, she stayed connected to the program. “They helped me with getting things like bottles, clothes, diapers. And if I needed a second to breathe, they would watch the baby for me. They helped me with stuff like baths. They just helped me with everything.”