More home-visiting support services needed to address maternal healthcare inequities in Michigan, experts say


Shane Ersland


Maternal health experts discussed the disparities Black women face in accessing care, as well as efforts to address them at the 2023 Michigan State of Reform Health Policy Conference last week.


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Michigan Council for Maternal & Child Health Executive Director Amy Zaagman said Black and brown women in the state are three times more likely to die from pregnancy-related causes than white women.

“And that trend has actually been increasing,” Zaagman said. “About 15 women in this state die every year because of complications through pregnancy and childbirth.”

Bianca Nash-Miot, founder of Birth Queens and Milk Queens—which offers birth doula and lactation counselor services for pregnant and breastfeeding families—said transportation is a key barrier to access.

“One of the biggest reasons people go into prenatal care late is transportation,” Nash-Miot said. “There’s a lack of access or availability to transit or get to your prenatal appointment. When we look at the overarching theme of why people are entering into prenatal care late, it’s because of lack of access. That’s really a systematic issue, and it’s a problem with the infrastructure of our communities because everyone should have access to a bus pass, or get to appointments.”

Kiddada Green, founding executive director of Black Mothers’ Breastfeeding Association, said lack of access is largely due to systemic racism. 

“We got here because this system was designed on racism,” Green said. “It was designed around commodifying the modification of Black bodies and Black women’s bodies. The impact of targeted mass marketing of infant formula underlying Black breastfeeding is real. There are companies framing their message around infant formula, where their goal is to target the person who struggles with breastfeeding. We know that tends to be Black families who have limited support for breastfeeding. These predatory marketing campaigns are very disturbing.”

Green said the state needs more availability of home-visiting support services to help struggling mothers. 

“One of the things I’ve been really troubled with over the years is home visiting support,” Green said. “That is very important. Why would I ask someone who’s just out of the hospital to come back to the hospital for support when we can use programs like (Special Supplemental Nutrition Program for Women, Infants, and Children), (federally qualified health centers), and Birth Queens to provide home visiting breastfeeding counselor support? We really need to get back in the mode of providing peers and community-based folks in the home.”

Nash-Miot agreed that it is important to meet people where they are. 

“When we meet people where they are, we are able to meet the needs they have, not the perception of the needs they have,” Nash-Miot said. “When you take the standard medical healthcare complex, you have a standard of care. But what happens when someone is in a situation, and the standard of care does not meet those needs? They fall through the cracks. Patient-centered care is important.”

Breaking down barriers to access and health equity will be key in helping local healthcare organizations establish relationships with new mothers, Nash-Miot said. 

“I’m hoping we can reclaim trust with some really good intentional work,” Nash-Miot said. “A way we can reclaim that trust is by working with grassroots organizations that have folks who gave birth in that community, who know what the issues are, and they are trusted by the community.”