For those expecting, equity is vital

Zachary Nieder, senior strategic initiative officer

Why is there a need to increase the number of perinatal workers of color in Rhode Island?

Doula Quatia (Q) Osorio, founder and executive director of the Urban Perinatal Education Center in Pawtucket, doesn’t hesitate in providing a straight, no chaser answer.

“Racism.”

Elaborating, the 40-year-old South Providence -raised mother added, “I am not going to sit here and sugarcoat it. This is not an ‘our’ problem. This is a ‘them’ problem, and the burden is on us to try to resolve what they created in our community.”

From Q’s perspective, there isn’t time to say it in a calmer, more digestible way.

“People are dying,” she said. “It’s life or death for us. It’s really hard to be the doula for someone who hired you because they don’t want to die. They are so scared, and they just want to have a good pregnancy and delivery.”

Rhode Island KIDS COUNT issued a brief earlier this year that confirms the national maternal health crisis that Rhode Island is NOT immune to. The first of several statistics (including some that are specific to Rhode Island) listed by the policy and advocacy agency further verify Q’s points:

• Nationally, compared with white women, Black women are three times more likely to die of pregnancy-related complications.

• Black women aged 35–44 years have the highest rate of risk factors, pregnancy complications, and death.

The brief continued, “Medical racism and interpersonal discrimination historically has impacted Black health and continues to impact Black birthing people today. According to data from the Centers for Disease Control, 80 percent of maternal deaths are preventable, signaling that there are deaths that could have been due to poor timeliness, quality of care, or inaccuracies in listening to patients’ needs.”

The work being done by the Rhode Island Perinatal Workforce Fund grant recipients are and will further help expectant families of color make the transition from pregnancy to parenthood safely.

Issued by the Rhode Island Foundation and created in March 2022 by the Office of the Health Insurance Commissioner (OHIC), the Fund provides valuable and timely resources to support and enhance the perinatal workforce in Rhode Island, including doulas. The Fund has a particular focus on expanding equitable and culturally congruent perinatal service to communities of color in Rhode Island.

With $375,000 total from Tufts Health Plan and United Healthcare of New England, the local recipients are:

• $200,000 to Urban Perinatal Education Center

• $85,000 to SISTA Fire

• $90,000 to Parent Support Network of Rhode Island

Each recipient is using the money to expand or focus on people of color in the prenatal workforce in different ways.

Q’s Center, for example, is using its $200,000 two-year grant to offer a range of trainings to strengthen the entire perinatal workforce. That workforce includes doulas (professionals who work with pregnant woman to provide guidance and support throughout the birthing process, labor, and post-delivery), midwives (trained medical professionals who serve as the healthcare practitioner in the absence of a doctor), lactation professionals, childbirth educators, and perinatal mental health advocates.

There are trainings planned for nearly every month in 2023, including, “Our Bodies: Restoring Black Autonomy and Joy” in April and another in August during Black Breastfeeding Week that focuses on the importance of the first food and supporting lactation professionals of color. In the summer, they are also teaming up with Movement Education Outdoors—another Rhode Island Foundation grantee—for a three-day restorative training series about mental health and boundary setting for perinatal workers.

Quatia, a doula who is in school to be a midwife, has trained 44 doulas of color in Rhode Island so far.

“We remain autonomous, judgment-free, and unbiased because we don’t work for the hospitals,” Q proudly said while explaining their critical importance, specifically for expecting families of color. “We work for the families, and we always give them the power: That is true, compassionate, patient-centered care.”

In 2017, Ditra Edwards won a $300,000 Rhode Island Innovation Fellowship from the Rhode Island Foundation to launch SISTA Fire. She and co-founder Chanravy Proeung have successfully co-created “a network of women of color and non-binary people of color to build our collective power for social, economic, and political transformation.”

The overall coalition focuses on economic empowerment, community-led action, healing, and wellness. The goal of its Doulas of Color Network is to sustain and strengthen doulas and birth workers of color.

“The [doulas] network is part of a strategy that we have to address the birth outcomes in our state,” said Edwards, who is also SISTA Fire’s director. “What we know is that healthy births go up 30 percent when there is a doula engaged in the process.”

The 18-month $85,000 grant from the Foundation helped to get this network further underway. It pays for creating monthly spaces for peer engagement and exchange, supporting advocacy efforts and training, and offering community building activities to strengthen connections.

Last summer, for example, network coordinators

Latisha Michel, Keyanna Benton, and Preetilata Hashemi held a community baby shower in the Olneyville neighborhood of Providence, which is also where SISTA Fire’s office is located. It included doulas giving demonstrations and was a chance to do outreach throughout the community with businesses including at a Manton Avenue barber shop.

While they agree no birth is the same, Keyanna said the network’s process of sharing their knowledge and experiences—such as debriefing tough births—helps them come up with best strategies together.

The network already has success stories. A 2021 Howard University graduate, Kayla Kinsler joined the network at the start of 2022, completing her training to become a certified perinatal doula that fall.

“It was through the connections of the network that I was able to do all that,” Kinsler said, “So I am really grateful, and I think that is an example of the impact it can make.”

The Parent Support Network of Rhode Island (PSN) operates much like its name. They work as a united, loving family that uses best practices and lived behavioral experience to empower each other and anyone else who needs support—especially families with children involved in special education, child welfare, and juvenile justice as well as adults who have experienced homelessness, mental health, and substance use challenges.

In addition, the Warwick-based organization strives to prevent abuse and neglect, reduce disparities, and progress towards universal health, wellness, and recovery. Its 18-month $90,000 grant is expanding PSN’s workforce of dual-certified community health workers of color who are peer recovery specialists with a focus on service delivery through the perinatal period.

“I was that teen mom and was treated with very little respect,” shared Brenda Alejo, PSN’s Bilingual Child and Family Program

Director. “My mother didn’t speak the language and culturally, it was unacceptable to have a pregnant teen daughter. The hospital did not provide [the help needed].”

Brenda, who identifies as Latina, continued, “My son is 35 years old and it’s sad that I am 52 and still seeing the same discrimination, the same disrespect, the same disregarding of our people.”

The Network’s Healing Mother & Baby program has peer recovery specialists that work with pregnant women who are struggling with substance use to assist with recovery and reduce perinatal substance exposure.

Through the birthing process and the first year, they help the expecting family or mother find an obstetrician-gynecologist and get services and support to prepare for becoming a parent.

The grant money is specifically used to recruit and train individuals of color to become peer specialists who work with the perinatal pregnant and parenting population. The goal is to provide 10 of these specialists with long-term, stable employment.

“We’re huge around cultural and linguistic competence and sensitivities, so everyone has to do six hours of implicit bias training right at the beginning,” Executive Director Lisa Conlan Lewis explained.

As she and the others continued, the loving family mentality made its way back into the center of why they do what they do.

She said, “It’s really about empathy and understanding and being able to meet people where they are at; it is also about understanding health equity and that we have to help each other collectively.”