A pregnant African American woman with her doula or birth support coach. The future mother, who … [+]
A recent Commonwealth Fund report again highlights how badly we are lagging behind globally in addressing inequalities in maternal health. We have been discussing and researching these disparities for over 20 years. Despite a sea of maternal health startups, these age-old disparities remain. So when I hear about a new maternal health startup, I’m skeptical and cynical, not believing that any of them will change this narrative.
I recently learned about a maternal health startup, Cayaba Care, whose mission is to provide access to comprehensive maternal health support. At first glance, reading about the organization didn’t ease my skepticism about the long-term value of maternal health startups. However, I was curious because Cayaba Care has a Black CEO, Dr. Adaeze Enekwechi, a health systems researcher with extensive experience in the health sector who is also a mother with her own stories about treatment during childbirth. I asked what sets the organization apart from what feels like an overabundance of maternal health startups doing similar things. “Our strength is in partnering with mothers, their doctors and the wider healthcare system. Because of this, we can see where the system is breaking down for the mother and intervene to help bridge the gap,” said she.
I still wasn’t convinced because her answer sounded like something most startups might say, so I pressed harder, wanting her to explain why their approach matters. Enekwechi says it’s about the team approach and the relationships the company builds with doctors and other care providers. “We’re not just app-based. This is a land play for us,” she said.
Dr. Enekwechi differentiates her organization from others by first hiring for empathy. She says communities have human capital, which is an overlooked resource, so they partner with trusted community organizations to find team members and screen them for empathy—for the right fit.
Attributing differentiation to empathy is tricky because it is a soft but instinctual ability that is easily dismissed as a predictor of outcomes and difficult to achieve. For Enekwechi, empathy involves a shared understanding of culture, background and family dynamics. Finding a team member who is right for the organization sometimes takes three months, but Enekwechi believes it is worth it. In a startup environment, the pressure to hire quickly can be overwhelming. Hiring mistakes and staffing inconsistencies are costly in 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 drivers of poor results. She says many of their members are scared and fearful of what the health care system will ‘do’ to them because they’ve heard through the grapevine about others having bad experiences, such as being ignored and are fired when they require care.
Dr. Enekwechi says the second difference is their insistence on building relationships with doctors and care teams. Traditionally, support services during pregnancy have been disconnected from clinical services, leaving patients to navigate on their own using a brochure, the Internet or a list of numbers to call to find help. In contrast, Cayaba Care fills this gap of information and support, creating peace of mind for the mother. Also, rather than occupying physical spaces, they seek to co-locate within provider offices, further building trust and collaboration with care teams. Enekwechi provided an example that is instructive for healthcare teams regarding SDOH screening. She says some people may feel too proud or embarrassed to admit food insecurity to a doctor, but these vulnerabilities are easily shared with the right navigator. Thus, the navigator can also serve as a communication bridge to help ensure the accuracy of information provided to care 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 of whom were black women and recently postpartum. Everyone 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 how they progressed through pregnancy.
Jasmine, a 35-year-old mother who had recently given birth to her third child, said: “During other pregnancies I had to do everything myself so I loved being able to call them 24/7 and someone I trusted would answer.” She developed high blood pressure during pregnancy and the team supported her by providing information on the impact of blood pressure on her pregnancy, what to look for and when to look for it. help This is critical, real-time support as one of the most common contributors to preventable morbidity in pregnancy is heart-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 the difference for Cayaba Care compared to her previous pregnancy was that the person assigned to support her was also a black mother with a similar background. She immediately felt comfortable with him, as if a friend was taking care of her. “You know there are some things you don’t want to ask the doctor or talk to them about because they might not understand or judge you. I can tell her anything,” she said. Rasheeda also noted that her navigator taught her self-advocacy and said, “Black women’s concerns are not taken seriously.” In a previous pregnancy, Rasheeda raised concerns about her history of anaemia, but this was not acted upon until her third trimester when she became symptomatic. She says that when a member of the Cayaba team accompanied her on visits, she believes her concerns were taken more seriously and plans to use her new self-advocacy skills for all future health care engagements.
As I spoke with Rasheeda, her examples provided some sunlight to help me better understand why we are 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 overlooked when assessing the causes of morbidity and mortality. For example, the main reasons for preventable maternal morbidity are mental health, cardiovascular and infection conditions. We categorize these things but have no context to understand what led to these diagnostic codes. Can a complication or fatality be avoided if someone is trusted to make the call? How do we assess whether or not people need this kind of support?
Our approach to maternal health in the US is primarily clinical and quantitative, focusing primarily on protocols, clinical metrics, and clinical predictors such as blood pressure readings or blood counts. These are important, but Rasheeda described the feelings of care, trust and confidence bestowed by a member of the Cayaba Care team. We do not actively and continuously measure or intervene in these during pregnancy. In fact, we have no framework to implement this systematically across healthcare teams in the US.
On reflection, I am much less skeptical about Cayaba Care’s ability to reduce maternal inequalities among those it affects. They already have early signals that their approach is saving money. The human-first approach they use involves deep listening and connecting with a trusted source of support, which is of high value to patients and the healthcare system. Dr. Enekwechi also says, “The health care 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 that you don’t know.”
If every organization embraces this humility and openness to the human elements of maternal care delivery, we are likely to be much more successful in addressing maternal health disparities.
Even if this approach is not immediately scalable, it can certainly be replicated nationwide, provides actionable recommendations for health policy makers, and highlights a path to achieving maternal health equity. This will require organizations to emulate Cayaba Care’s efforts to slow down, listen, build trust and tailor support to each person’s needs. Perhaps then, in another 20 years, we will finally see dramatic changes in our shameful maternal health outcomes.
