May 20, 2015

Group Works to Close the Health Care Gap for Poor Mothers of Color

Reporting Texas

Michelle Mejia looks on while her son plays with a few other children on a playground in North Austin. Photo by Lauren Lowe

Michelle Mejia said the Mama Sana nonprofit helped her through her pregnancy and the home birth of her son, Francisco, in 2013. She watched recently as he played with other children at a North Austin playground. Photo by Lauren Lowe for Reporting Texas 

Two years ago, Michelle Mejia, a recent college graduate hoping for a career in radio, was working two part-time jobs when she discovered she was pregnant. For her and soon-to-be husband Andres Leal, happiness was tempered by concern about their finances.

“Since I wasn’t employed anywhere full time, I couldn’t take paid time off,” said Mejia. Losing her income would hurt when she stayed home to care for her newborn. In addition, Mejia had never had health insurance and worried about navigating the health care system.

Then the couple got a lucky break. A friend told Mejia about a small organization called Mama Sana/Vibrant Woman, which helped her apply for Medicaid and found a midwife to oversee the home birth of her son, Francisco, in October 2013.

Mama Sana “prepared me for birth as an experience … My midwife gave me books on pregnancy and recommended nutritious foods,” said Mejia, now 26 and working at Resistencia Books in East Austin. “I felt so loved and reassured that all the fears and worries I had went away.”

Mama Sana/Vibrant Woman — or Healthy Mother/Vibrant Woman — is a collective of women in East Austin on a mission to improve pregnancy and birthing experiences for low-income women and to bring down high infant mortality rates for babies born to women of color. The founders were motivated by what they saw in their communities and the discrimination they experienced in the health care system, such as doctors and nurses making unfounded assumptions about ability to pay or to make informed decisions about care.

Working on a shoestring donations budget of $5,000 to $7,000 a year, they provide women with access to a half-dozen doctors and midwives who volunteer their services free of charge.

“The woman decides what she wants, whether it’s a home birth or hospital delivery,” said Paula Rojas, who co-founded Mama Sana with five other women in 2011. The group has so far guided about 20 women through their pregnancies and births. Mama Sana is part of a larger organization, Mamas of Color Rising, which focuses on housing, education and safety issues.

While its footprint is small, the organization’s ambitions are big.

Mama Sana is one of a number of nonprofits that have taken root in Austin to fill gaps in medical services for low-income women. Among them are the Alliance for African-American Health in Central Texas; People’s Community Clinic, which offers a prenatal program for low-income women; and El Buen Samaritano, which helps undocumented immigrants who are hesitant about using the traditional health care system because of their vulnerable legal status.

In Texas, uninsured low-income women can get Medicaid while they are pregnant, but the coverage ends two months after they give birth. Children born to undocumented women qualify for the state’s Children’s Health Insurance Program, but CHIP does not include the mothers. Community organizers say their services are needed because both government programs have limitations.

“Even having Medicaid may not get you great access to care,” said Anne Dunkelberg, associate director at the Center for Public Policy Priorities, a nonpartisan nonprofit in Austin. “Some women have to wait a while for their first appointment, when ideally [they] should see a doctor within the first two weeks” of pregnancy.

Texas’ decision to reject the Medicaid expansion option of the Affordable Care Act is contributing to the chronically high number of uninsured women in the state, Dunkelberg said.

In the past three years, two programs were created to connect community health workers with low-income pregnant women of color: the City of Austin’s Maternal Infant Outreach Program and Travis County’s Healthy Families. Both are funded by a federal Medicaid grant. The health workers provide home visits and support after the women give birth and help clients navigate the health-care system for up to a year after they give birth. However, neither program provides delivery services. Mama Sana is the only organization in the county whose model combines a support system and birthing services.

Rojas said women of color encounter a lack of compassion and understanding from health care providers regardless of their socioeconomic status.

For example, she said, “We need culturally specific prenatal care for African-American women, such as black providers and support groups … You can have the best care that says you should be eating all organic and that kind of stuff, but it doesn’t necessarily relate to people’s cultural aspect.”

Rojas says another motivator for Mama Sana has been the health disparities between mothers of color and their white counterparts. According to data from the Department of State Health Services, black women have far higher rates of infant mortality, lower birth-weight babies and more preterm births than white women; Hispanic rates fall between the two. The infant mortality rate for black babies in Texas was 11.6 percent in 2012, compared to 5.8 percent for white babies. In Travis County, the disparity is even wider, according to March of Dimes PeriStats – 12.5 percent for African-American, 5.5 percent for Hispanic and 4.9 percent for white babies.

“There’s the health condition of a woman before she gets pregnant … that’s going to have an effect,” said Dr. David Lakey, associate vice chancellor for population health for the University of Texas System. The higher rate of obesity among black women is one example, he said. There are also issues with access to care, since more black and Hispanic women don’t get prenatal care until late in their pregnancies.

“Every woman deserves to have a good experience when they’re having their baby,” said Lourdes Kaman, a Mama Sana cofounder who is a birth companion, providing assistance to women before and after birth. “For women of color, sometimes they don’t even have a choice.”