Data will be obtained from North Carolina State Center for Health Statistics

Story Behind the Indicator

What's helping/working?

These are the positive forces at work in our community and beyond that influence this issue in our community.

• Mothering Asheville coalition and social justice movement
• Home Visiting Programs / Collaborative, including, but not limited to: MotherLove at the YWCA, Nurse Family Partnership, Pregnancy Care Managers, Project NAF, SistasCaring4Sistas Doulas for Social Justice (SC4S), Verner Center for Early Learning, and Asheville Buncombe Institute for Parity Achievement (ABIPA)
• Doulas (particularly doula groups like SC4S who employ community members of color and serve families facing increased barriers, risks, or stigmas)
• Building trust through meeting patients where they are
• Programs with a holistic approach like ABIPA
• Increased efforts to tackle provider bias (for example, at MAHEC)
• Providers & clinical staff going through the Racial Equity Institute (REI)
• Preconception health
• Improved reproductive health counseling, education, services (Title X)
• Increased men mentoring boys (specifically on fatherhood, manhood, etc.)
• Increased young men's involvement/participation in birth/parenting
• Increased nonprofits working with youth comprehensively (for example, My Daddy Taught Me That (MDTMT), My Sistah Taught Me That (MSTMT), Youth Transformed for Life, and others)

What's hurting?

These are the negative forces at work in our community and beyond that influence this issue in our community.

• Lack of affordable housing
• Need for living wage
• Racism/White Supremacy Culture
• Inequities/Institutional racism in schools
• Lack of diversity of providers
• Provider bias/racism and patient biases that create barriers to trust and impair receiving quality health care
• Providers not listening to what women want
• Trauma: including historical personal trauma impacting the birth experience, and traumatic birth experiences impacting well-being
• School to prison pipeline
• Unsafe/unhealthy work conditions - lack of true living wage and high rental costs
• Inadequate childcare, poorly-supported parents
• Poverty and inadequate housing
• Generational trauma
• Failure to expand Medicaid
• Abstinence-only education in schools, lack of access to appropriate and comprehensive sexual health centers and information
• Inadequate family planning, threat to planned parenthood, politics, domestic violence, education/drop-out rate, not enough school nurses and mental health professionals
• Healthcare with high deductibles or that doesn't cover needed resources

Partners With A Role to Play

• CHIP Advisory Council members/agencies

• YWCA-Asheville

• Project Nurturing Asheville and area Families (NAF) – Mount Zion Community Development

• Asheville Buncombe Institute for Parity Achievement (ABIPA)

• Sistas Caring 4 Sistas (SC4S)

• MAHEC

• Buncombe County Women, Infant, and Children (WIC)

• Buncombe County Care Management & Nurse-Family Partnership programming

Strategies Considered And Process

What's Helping What We Do?

These are the positive forces at work in our strategy/ program that influence how much we do or how well we do it.

• BIPOC-led birthing services, doulas, and advocates
• Addressing root causes: systemic racism, intergenerational trauma, imbalances with access to social determinants of health
• Collective Impact frameworks, including Mothering Asheville movement

What's Hurting What We Do?

These are the negative forces at work in our strategy/program that influence how much we do or how well we do it.

• Racism and white supremacy culture within healthcare and social service systems
• Financial and housing instability - low paying jobs, poverty, lack of safe and affordable housing
• Ongoing need for increasing male involvement in birthing and pregnancy services

The following actions have been identified by our CHIP Advisory and Community Listening Sessions as ideas for what can work for this performance measure to make a difference on birth equity.

(A) Actions and Approaches

These are actions and approaches that we think can make a difference for this performance measure.

• Increase early access to BIPOC-led doula and birthing services
• Implement ongoing provider bias training that incorporates a robust racial equity framework
• Focused efforts on root causes and imbalanced access to social determinants of health

(B) No-cost and Low-cost Ideas

These are no-cost and low-cost actions and approaches that we think can make a difference for this performance measure.

• Racial equity education and awareness - Racial Equity Institute (REI), Building Bridges, WNC Diversity Engagement Coalition
• Increase knowledge of current pregnancy & postpartum support programs within the community (both commuinty and
• providers)
• Increased numbers of mothers who breastfeed their babies

(C) What BIPOC Buncombe County residents think would work to do better

These are actions and approaches that our community thinks can make a difference for this performance measure.

• Apply and require ROBUST racial equity training (& beyond) for providers across the board
• Increase root cause trainings (as being done by ABIPA and other boots on the ground nonprofits)
• Support engagement of fathers/partners in reproductive care, pregnancy, and parenting

(D) List of Questions/Research Agenda

These are questions to follow-up on.

• What does finalized data from the 'one question' campaign identify for alternative solutions?
• What policy-level interventions and strategies can be paired to improve progress on this health focus area and associated performance measures?