A pregnant African American woman with her doula or birth coach. The expectant mother, that one … [+]
A recent report from the Commonwealth Fund reaffirms how seriously we are falling behind in addressing maternal health disparities globally. We have discussed and explored these differences over 20 years. Despite a crowded sea of maternal care startups, these long-standing disparities persist. So when I hear about a new start-up in the maternal care space, I am skeptical and cynical, and I don’t believe any of them will change this narrative.
I recently heard about a maternal health startup, Cayaba Carewhose mission is to ensure access to comprehensive maternal health care. At first glance, reading about the organization didn’t dispel my skepticism about the long-term value of maternal care startups. However, I was curious because Cayaba Care has a black CEO, Dr. Adaeze Enekwechia healthcare systems researcher with extensive experience in the healthcare sector, who is also a mother with her own stories of treatment during childbirth. I asked her what sets the organization apart from what seems like a plethora of maternal care startups doing similar things. “Our strength lies in working with mothers, their doctors and the broader healthcare system. This allows us to see where the system is breaking down for the mother and intervene to bridge the gap,” she said.
I still wasn’t convinced because her answer sounded like something most startups would say, so I pressed even more and wanted her to explain. Why their approach is important. Enekwechi says it’s about the team approach and the relationships the company builds with doctors and other healthcare providers. “We’re not simply app-based. This is a grassroots game for us,” she said.
Dr. Enekwechi differentiates her organization from others by hiring for empathy. She says communities have human capital, which is an overlooked resource, so they work with trusted community organizations to find team members and screen them for empathy – for the right fit.
It is difficult to attribute differentiation to empathy because it is a soft but instinctive skill that can be easily dismissed as a predictor of outcomes and difficult to get right. For Enekwechi, empathy involves a shared understanding of culture, background and family dynamics. Finding a team member who fits the organization can sometimes take up to three months, but according to Enekwechi it is worth it. In a startup environment, the pressure to hire quickly can be enormous. Hiring mistakes and staff mismatches cost a lot of time and money. She believes the company’s methodical approach to finding the right fit for the Cayaba Care team improves long-term results because fear is one of the biggest causes of poor outcomes. She says many of their members are afraid of what the health care system will “do to them” because they have heard through the grapevine about others with bad experiences, such as being ignored and rejected when seeking care.
Dr. Enekwechi says the second differentiator is their emphasis on building relationships with physicians and care teams. Traditionally, support services during pregnancy have been separated from clinical services, leaving patients to find their own way using a pamphlet, the Internet or a list of numbers to call to find help. Cayaba Care, on the other hand, bridges this information and support gap and creates peace of mind for the mother. Additionally, rather than acquiring physical spaces, they seek to collaborate within providers’ offices, further building trust and collaboration with care teams. Enekwechi gave an example that is instructive for healthcare teams SDOH screening. She says some people may feel too proud or ashamed to admit food insecurity to a doctor, but these vulnerabilities are easily shared with the right navigator. So the navigator can also serve as a communication bridge to help ensure the accuracy of the information provided to healthcare teams.
After my conversation with Dr. Enekwechi I was intrigued, but remained skeptical. I wanted to hear directly from people who had received services from Cayaba Care. I spoke to three women, all black women and recently postpartum. They all agreed that Cayaba Care made their pregnancy journey easier. Two of them had previous pregnancies with various complications, and both felt that Cayaba Care made a difference in the progress of the pregnancy.
Jasmine, a 35-year-old mother who had recently had her third child, said: “During my other pregnancies I had to do everything myself, so I loved that I could call them 24/7 and someone I trusted would answer. ” She developed high blood pressure during her pregnancy and the team supported her by providing information about how blood pressure affected her pregnancy, what to look out for and when to seek help. This is crucial, real-time support since one of the most common causes of preventable morbidity during pregnancy is heart disease-related conditions such as hypertension. She also said, “Sometimes it just helps to know you have support, even if you just have a question and it’s not an emergency.”
Rasheeda G. recently gave birth to twins and also praised the Cayaba Care team. She felt that the differentiator for Cayaba Care from her previous pregnancy was that the person assigned to support her was also a black mother from a similar background. She immediately felt at ease with her, as if she were being cared for by a friend. “You know, there are things you don’t want to ask the doctor or talk to them about because they might not understand or judge you. I can say anything to her,” she said. Rasheeda also noted that her navigator taught her to stand up for herself, saying, “Black women’s concerns are not taken seriously.” During a previous pregnancy, Rasheeda raised concerns about her history of anemia, but this was not addressed until her third trimester, when she became symptomatic. She says that when a Cayaba team member accompanied her on the visit, she felt her concerns were taken more seriously and planned to use her new self-defense skills for all future healthcare activities.
When I spoke with Rasheeda, her examples offered a little sunlight to help me better understand why we’re not reducing maternal health disparities. Her experiences with Cayaba Care were not about something clinical and quantitative, but about connection, something qualitative. These qualitative differences are likely to be ignored when evaluating the causes of morbidity and mortality. The main reasons for preventable maternal morbidity include mental health problems, cardiovascular disease and infections. We categorize these things, but have no context to understand what led to these diagnosis codes. Can a complication or fatality be avoided by trusting someone to call? How do we judge whether people need this kind of support?
Our approach to maternal health in the US is largely clinical and quantitative, focusing primarily on protocols, clinical metrics, and clinical predictors such as blood pressure measurements or blood counts. These are important, but Rasheeda described the feelings of care, trust and confidence that a Cayaba Care team member provided. We do not actively and consistently measure or intervene in this during pregnancy. In fact, we don’t have a framework to apply this systematically across healthcare teams in the US.
When I think about it, I am much less skeptical about Cayaba Care’s ability to reduce disparities among mothers among those they come into contact with. They already have early signals that their approach saves money. The people-centered approach they take includes deep listening and connecting to a trusted source of support, which provides great value to patients and to the healthcare system. Dr. Enekwechi also says: “The healthcare system is too limited to help people. We can help close the gap, but we must remember that the most important requirement in scaling our work is a heavy dose of humility and assuming you don’t know. “
If every organization embraces this humility and openness to the human elements of maternal care, we are likely to be much more successful in addressing maternal health disparities.
Although this approach is not immediately scalable, it is certainly replicable nationwide, provides actionable recommendations for health policy makers, and highlights a path to achieving maternal health equity. This requires organizations to match Cayaba Care’s efforts to slow down, listen, build trust and tailor support to each person’s needs. Maybe then, in another twenty years, we’ll finally see dramatic shifts in our shamefully embarrassing maternal health outcomes.