Colorado Access partners with nonprofit to improve Black maternal health outcomes


Shane Ersland


A Colorado health plan is now working with a nonprofit organization in an effort to reduce health disparities among Black birthers.

Colorado Access recently began a partnership with Mama Bird Doula Services, which offers doula support and perinatal care and education to families in Denver and Aurora. Colorado Access, the state’s largest Medicaid health plan, collaborated with nearly 50 stakeholders (including Black community members, birthing workers, and advocates) to establish a vision and design solutions to improve Black birthing health.

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Joy Twesigye, vice president of health systems integration at Colorado Access, told State of Reform that the health plan wanted to do something innovative in the maternal health space.

“The project was born out of a call with anyone who was interested in having a conversation about women’s health and maternal health from a variety of angles,” Twesigye said. “It started broad and large, and we had conversations about what was important to people. Colorado Access was there to listen, learn, and find a solution that was reasonable and feasible to do. People pitched different ideas, and the idea that there would be a project around doulas was born.”

Since the Centers for Disease Control and Prevention implemented the Pregnancy Mortality Surveillance System in 1986, maternal mortality rates in the US have increased steadily. Maternal mortality rates rose from 7.2 deaths per 100,000 live births in 1987 to 17.2 deaths per 100,000 live births in 2015. The rate increased to 32.9 in 2021.

Data collected in 2022 from the Colorado Hospital Association shows that Black moms are 53 percent more likely to experience severe maternal morbidity (which can include heart failure, eclampsia, hysterectomy, and blood infections) than their white counterparts. Native American mothers are 98 percent more likely to experience severe maternal morbidity as their white counterparts.

“[The project] started with the idea that these overtones are not great both nationally and in Colorado, and that access to doulas would be a real reliever, and hadn’t been done for people on Medicaid. People in the community and Mama Bird decided they wanted to increase access, but in order for that to happen, part of what makes doula care successful is having people who reflect you in the state of understanding your lived experience and background. And there was a real desire to think about workforce training, so we’re not leaving BIPOC doulas out.”

— Twesigye

Through the partnership, 40 Black birthing families are receiving Medicaid-covered doula support. And 24 doulas who identify as Black, Indigenous, or people of color are receiving training, entrepreneurship tools, and mentoring in order to better respond to the unique needs of their communities and create career pathways in birth work.

The project aims to demonstrate that with suitable compensation, comprehensive training, and opportunities for advancement, the BIPOC doula workforce can reduce disparities for Black birthers in Colorado. Colorado Access also believes the project can have informative power on policies around Medicaid-covered doula services.

“The literature states that having a doula is helpful, so we wanted to increase that access,” Twesigye said. “Then there’s a conversation about training and certification, which is why we were looking forward in workforce development. For us, what’s really important is it is possible for health plans to have real community engagement and let community members lead in what makes sense for a solution for them. We need to go to the folks who are impacted and support them.”

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