Bringing Community Health Workers to DC

Aza Nedhari is the co-founder and Executive Director of Mamatoto Village, a non-profit organization that trains and provides perinatal community health workers for some of Washington DC’s most high-risk mothers.

She’s also a home-schooling mother of three, has a master’s degree in marriage and family therapy and is a midwife. Nedhari, along with co-founder Cassietta Pringle, developed the program in response to the tragic fact that African American women are four times and Latina women two times more likely to die from pregnancy-related causes than white women.

Every Mother Counts: Aza, your program is similar to ones we’ve seen in developing countries that need to dramatically boost their healthcare workforce. It’s very unique for the U.S. though. Tell me what Mamatoto is all about.

Nedhari: Mamatoto is a 501©(3) with a two-part mission. Part one is that we train perinatal community health workers (PCHWs) using an in-depth curriculum that covers a range of services many women of color need during their perinatal life course. We help pregnant women (and their partners) have healthy pregnancies and experience the transitions to parenthood, in a self-determined and empowered way.

EMC: Tell me more about the training program.

Nedhari: Our Perinatal Community Health Worker training is a comprehensive 14-week program covering the perinatal period, pregnancy, birth, postpartum, and breastfeeding. Our training is unique in that we have created a specialty within community health work. Essentially it is a workforce training program, providing transferrable skills, but also functioning as a stepping stone into a variety of professions; public health, midwifery, and human/social services to name a few. After training, our PCHWs are mentored and begin to work directly with clients. This work involves home visitation, teaching classes, helping mothers navigate the system and connecting them with resources. The goal is to help them have a healthy pregnancy, birth and transition to parenthood. They follow their clients from the beginning of their pregnancies and through their labor and birth. Then, they see them at home and make sure they’re well and breastfeeding. The PCHW and client continue this relationship until the child turns one and sometimes, beyond that.

EMC: How is a perinatal community health worker different from a doula?

Nedhari: We offer doula services at Mamatoto and it is beneficial for many women. But, a doula’s scope is limited to the short period of time around birth and the six-week post partum period. To me, the question is, ‘who needs a doula and who needs a PCHW?’ In my opinion, doulas are for mothers who aren’t worried about their basic necessities being met; the mother who needs education and maybe some advocacy; and would like support to have the birth she envisions. This is not the mother who has a host of psychosocial factors and social determinants that lead to poor health. She’s not homeless or getting evicted. She hasn’t lost her low-paying job. This woman doesn’t need someone to provide counseling or mental health resources for issues that may or may not be biologic in nature. Many of our clients are depressed because their situations are extremely challenging. Doula training really sets her up to impact birth outcomes, not outcomes along the perinatal life course.

EMC: Tell me about more the mothers who need Perinatal CHWs?

Nedhari: As I mentioned above, these women need a professional with a different skill set to help them navigate the system. Our perinatal CHWs work with the hard to reach moms, who are high risk due to physical and/or social factors. Moms who have mental health issues, coupled with other social determinants that impact their ability to have a healthy pregnancy and transition to parenthood. Most of the moms we work with have challenges with basic necessities like housing and food insecurity. They may or may not have a parenting skills. They may be having their first child or their fifth with no father present for any of the children. Being pregnant is just one extra thing in her life and she might not be able to make it her primary focal point.

EMC: Are perinatal CHWs able to make a living wage after they leave your program?

Nedhari: Yes, but many PCHWs do this in addition to other jobs or as a way to bring in some income while they’re caring for young children or pursuing their careers or education in other areas. With that said, it’s possible to do this full time and make a decent living. This program is designed to be a stepping-stone into the profession. We mentor our PCHWs and help them set and meet goals for their families, careers and lives.

When they’re finished training, these women work for our organization as contractors for a year, gaining skills and knowledge specific to perinatal health. Some of the women who’ve gone through our work-force training program have gone on to study social work, public health, lactation, nursing and midwifery. Some originally came to us as clients when they were pregnant, which leads me to part two of our mission — the direct service piece.

EMC: Where does the money come from to cover client services and the Perinatal Community Health Worker training program?

Nedhari: Most of the people in our training program pay tuition. We do have a limited work-study program for moms under age 24. We received an award from the Rosalyn Jaffe Foundation that helped us launch, grow and gain exposure. Then, we were able to negotiate contracts with two Managed Care Organizations to provide maternity support services, care coordination, counseling, and more to their clients. After seeing our 1-year outcomes, they were impressed and believed we help them meet their benchmarks and serve their most vulnerable clients. We’re hoping to add other MCOs soon, which will help keep our program sustainable. The whole idea is to keep training and hiring women in the community to support other women and families in the community.

Visit www.mamatotovillage.org to learn more about their work to improve maternal health outcomes in DC.