Birth Workers of Color Creating Their Own Systems

In the Spring of 2019, Quatia Osorio made a big decision: she was going back to school. The Providence, Rhode Island, resident had decided to enroll in a Midwife program, to build upon the work she had been doing as a maternal health worker and doula in her community. Then came the question of what her absence would mean for her community.

“I realized that I would be leaving my work, but I didn’t want there to be fewer services for mothers of color,” she told us. “Right now, there are only 2 black women birth doulas in the entire state of Rhode Island.”

Maternal health in the U.S. is harshly divided across racial lines. According to recent reporting on government data “black infants in America are now more than twice as likely to die as white infants — 11.3 per 1,000 black babies, compared with 4.9 per 1,000 white babies, according to the most recent government data.” And Osorio believes that the lack of accessible and culturally-relevant medical services available to black communities and other communities of color is a driving factor of this crisis. 

The numbers on today’s maternal health outcomes are accompanied by a long history of violent racism towards black women and pregnant people in the medical system. This history includes gynecological experimentation on black women in slavery and the forced sterilization of Latinx and Native American women in the United States. 

These legacies persist in contemporary accounts of poor treatment, discrimination, and microaggression in the health system, leading many people of color to experience the medical system as a site of trauma. Across the country, black midwives and doulas have become outspoken about the need for specific care for black women in the midst of a reproductive health crisis. As policy-makers begin to pay attention to the impact of doulas and midwives - such as HB5609, a bill in the Rhode Island House of Representatives that would expand medical coverage to include perinatal doula services - having culturally-relevant training programs for birth workers of colors becomes even more imperative. 

“Reproductive justice is a cornerstone of our framework to dismantle those negative determinants and biases that continually manifest themselves in poor birth outcomes and mental health issues,” states Osorio. “One of the ways this continues in the medical system is poor or negligent referral relationships with cultural humility- and cultural sensitivity-trained mental health therapists, poor or negligent life skills training, and little or no proper maternal health education, advocacy or support within these systems.”

Feeling the weight of her community’s need, Quatia decided she would host a training series for mothers and others interested in being maternal health workers or supporters. The money to put on this series would be an issue, but Quatia was committed to seeing it through, even spending her own money to make sure the classes had all the proper equipment.

“We had to spend, like, $600 on a model Pelvis. I knew I wouldn’t be able to fundraise for it, because, who is going to believe me that we need to spend $600 on a model Pelvis?!” 

Out of these trainings, a new collective - Umoja Nia - was formed. Their vision is to create, engage, and promote a cohort of multicultural, professionally-trained maternal health birth workers including community health workers, doulas, birth assistants, and midwives to promote and activate community-level maternal care to those in need. For Umoja Nia, “those in need” especially includes members of vulnerable populations: disadvantaged or stigmatized teen mothers and other low resource and low-income families outside of regular routine services - especially those that overlook their emotional and psychological well-being. 

While Osorio might be stepping back from her immediate role in this work, she knows that the commitment to providing holistic, compassionate, culturally-relevant care will continue to grow - and she and Umoja Nia have set up the systems to ensure it will be met with resources and support.

Guiding Practices:

Primary issue area:

Environmental Health