Stephanie Spencer is the founder and executive director of Urban Baby Beginnings (UBB), a community based organization focused on providing care to families during pregnancy and with young children. UBB’s goal, according to Spencer, is to address systemic barriers to care, especially for Black and Brown families.
In this Q&A, Spencer discusses Medicaid expansion, the pandemic’s impact on maternal health, and UBB’s goal to train more community-based doulas of color.
Nicole Pasia: Discussions about addressing the social determinants of health (SDOH) through community and outcomes-based services have come up in both the health care sector and in public policy. Last month, UBB received a $250,000 grant from UnitedHealthcare to support community-based services that help address SDOH. How is the grant and other SDOH-based actions influencing health care and health policy at large?
Stephanie Spencer: “90% of what’s happening [to patients] is in the community. It’s not really happening at the hospital level. So when we talk about addressing social determinants of health, it gets very difficult to do that when funding is not pivoted to the community that works with its community members, the majority of the time.
We were really excited that United Healthcare recognized the need for building the workforce for community doulas, and just how important that was to have boots-on-the-ground people that look like the individuals that they were serving…We need to see more commitment from larger organizations and stakeholders in terms of making sure that funding is received so that programs can do what they need to do, and so that they’re sustainable and can have the reach that’s necessary to make positive change in the communities they’re serving.”
NP: What services at UBB are you planning to support with the additional funding?
SS: “This funding is specific for building workforce, [and] utilizing community doulas of color…A community based doula is a doula who often has shared lived experiences with the person that they’re serving. They’re trained to provide extended and culturally congruent support to families during their pregnancy to include like the antepartum antepartum period, all the way through up to the first year postpartum.
So, our program actually trains community doulas to do this work with that pregnant and postpartum person by providing support resources and education during those times. Our goal is to train 400 [into the] workforce across the state of Virginia, over the next two years with this particular funding.”
NP: How have you seen the pandemic affect maternal health outcomes?
SS: “[The pandemic has] really been a challenge, and more specifically for our Black and Brown families. It’s been very isolating for the maternal population. When COVID first hit, there was not a lot of information, especially on how it was impacting our pregnant moms and their babies.
So whereas, at some point, the vaccine was available, pregnant folks didn’t necessarily know how it was going to impact them. We still have concerns over that.
Also just pregnancy and the postpartum period is not meant to be done in silo. Across the United States, there were a lot of hospitals that responded to protect the hospital space [by] reducing the number of visitors that were allowed in hospital settings. What that meant was a lot of doulas who provided support to clients couldn’t, because they the parent had to make a choice between if they allow their significant other, a family member in or a doula.
…What we saw during COVID was really, increased levels of maternal mental health issues like postpartum depression, depression and anxiety in general, a lot more preterm births than what I would care to see.”
NP: How did the pandemic affect access to care?
SS: “Having access [to care] was truly an issue. [UBB has] the largest diaper bank in the state of Virginia. We gave 2.9 million diapers out for that first year, just for COVID alone, [for] a little over 7500 babies. That’s a lot of babies and a lot of needs. So imagine that, and change that to something like food, when we start talking about these critical things that people need in order to have healthy outcomes…
…It was just really a lot for the families. Being stressed, not having the same levels of access, not knowing where to go…they couldn’t find the resources they would normally rely on, they just weren’t accessible.
So as the world is starting to wake up today, it looks a little bit different. Obviously the moms have a little bit more support, but it’s not anywhere near what it needs to be. That’s why this programming is so great, because as we continue to expand it’s going to give these families more support and reduce that risk of isolation and the subsequent impacts of…maternal mental health issues, preterm birth, just isolation overall.”
NP: What legislation are you following that has supported maternal health in the Commonwealth?
SS: “Urban Baby Beginnings has been one of the critical community-based organizations that has been around a table talking about the need for legislation to support families from a health equity lens. Some of our work really has focused on the expansion of Medicaid for pregnant and postpartum folks, up to one year. We’re working on, hopefully, home visiting legislation which will give extended support to families during the pregnancy through early childhood years. I really want to see focus on continuing to expand social support programming for families across the state of Virginia and making it accessible, regardless of income or ability to pay.
One of the things that just recently came out was an expansion of Medicaid to our undocumented population. And that’s up to 60 days — we need to see that extension up to a year. So those are some of the things…that we really need to see so that our mothers have the best chances of having the best [health] outcome.”
This interview was edited for clarity and length.