Addressing Black Maternal Health at a Critical Entry Point

By Jennifer Kawatu, RN MPH and Naomi Clemmons, MPH

The U.S. is facing a maternal health crisis; our maternal* mortality rate is the highest of any industrialized nation. Black women are three times more likely to die of pregnancy-related causes than White women, and more than 80% of maternal deaths are preventable. Many efforts to reduce maternal morbidity and mortality focus on the pre- and perinatal periods, but 53% of pregnancy-related deaths occur between one week and one year after pregnancy (1).

The federally funded Title X family planning program serves over 2.6 million patients per year across all 50 states and U.S. territories. Given that six of 10 patients describe it as their “usual source of care,” Title X providers have a crucial role in providing comprehensive and preventive health services that affect maternal morbidity and mortality. They are well positioned to address health issues that impact the individual and any future pregnancies (2).

Title X providers can develop ongoing trusting relationships with patients. Having a trusted provider is especially important for Black birthing people, who are more likely to report being treated unfairly because of their race (3). Unsurprisingly, those who reported being treated unfairly were less likely to seek care and more likely to report worse health outcomes. Dr. Keisha Callins, a Title X provider in Jeffersonville, Georgia, loves the quote “Change happens at the speed of trust.” (4)

When you have a trusting relationship with a patient, it is the foundation for how things move forward. If you get to know that patient, and they start to trust you, you can kind of talk about their goals and their long-term plans to address their reproductive concerns. That birth control conversation really is just a connection point for care and then after that happens, you can get into other things that are going on.” – Keisha Callins, MD, MPH, Community Health Care Systems, Inc.

It is not surprising that so many patients rely on their Title X provider because the program requires services to be person-centered, culturally and linguistically appropriate, inclusive, and trauma-informed (5). Staff must broadly represent the populations served, and be trained in cultural humility, among other things. In addition, Title X agencies must engage with their communities to develop, implement, and evaluate their programs.

Title X programs are also a vital entry point to a larger system of care (6). They coordinate referrals and facilitate linkages to other health, community, and social services, resulting in a seamless continuum of care (7). Recognizing the profound influence of social and structural determinants of health, Title X programs are increasingly screening for health-related social needs and integrating community health workers and patient navigators into their service delivery model to connect patients to additional services. Building relationships with community partners can establish reciprocal referral pathways, enabling them to better meet patients’ needs.

The Black maternal health crisis has been described as a “wicked” problem that is socially and culturally entrenched and requires myriad upstream prevention strategies. As an important entry point into care, the Title X Family Planning program has the potential to improve Black maternal health by ensuring whole-person health and well-being through the delivery of person-centered care. JSI is committed to advancing sexual and reproductive health equity by supporting Title X agencies through the Reproductive Health National Training Center and other projects.

The Reproductive Health National Training Center, managed by JSI Research & Training Institute, Inc., is a collaboration with the Office of Population Affairs and the Office on Women’s Health in the Office of the Assistant Secretary for Health to address the needs of Title X family planning service delivery grantees and Teen Pregnancy Prevention grantees through training and technical assistance. Sign up for the RHNTC newsletter to hear about upcoming events and new resources.

*While the term “maternal” is used, it is recognized that not all people capable of pregnancy may identify as “mothers,” “women,” or with the word “maternal.” We recognize that individuals with other gender identity or expression may also become pregnant and give birth.