A pregnant African-American woman with her doula or birth support coach. The expectant mother, who … [+]
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A recent Commonwealth Fund report again highlights how badly we are falling behind globally in addressing maternal health disparities. We have been discussing and researching these disparities for over 20 years. Despite a crowded sea of maternal health startups, these longstanding disparities remain. So, when I hear about a new maternal health startup, I am skeptical and cynical, disbelieving that any of them will change this narrative.
I recently learned about a maternal health startup, Cayaba Care, whose mission is to ensure access to comprehensive maternal health support. At first glance, reading about the organization did not alleviate my skepticism about the long-term value of maternal health startups. However, I was curious because Cayaba Care has a Black CEO, Dr. Adaeze Enekwechi, a health systems researcher with vast experience across the health sector, who is also a mother with her own stories about treatment during childbirth. I asked her what differentiates the organization from what feels like an overabundance of maternal health startups doing similar things. “Our power is in partnerships with moms, their doctors, and the broader healthcare system. Because of this, we can see where the system is breaking down for the mom and step in to help bridge the gap,” she said.
I was still not convinced because her response sounded like something most startups might say, so I pressed more, wanting her to explain why their approach matters. Enekwechi says it is about the team approach and the relationships the company builds with doctors and other care providers. “We are not simply app-based. This is a ground game for us,” she said.
Dr. Enekwechi differentiates her organization from others first by hiring for empathy. She says communities have human capital, which is an overlooked resource, so they partner with trusted community organizations to find team members and screen them for empathy—for the right fit.
Attributing differentiation to empathy is tricky because it is a soft but instinctive skill that is easily dismissed as a predictor out outcomes and tough to get right. For Enekwechi, empathy includes a shared understanding of culture, background and family dynamics. Finding a team member that is right for the organization sometimes takes three months, but Enekwechi believes it is worth it. In a startup environment, the pressure to hire quickly can be enormous. Hiring mistakes and staffing mismatches are costly in time and money. She believes the company’s methodical approach to finding the right fit for the Cayaba Care team improves long-term outcomes because fear is one of the biggest drivers of poor outcomes. She says a lot of their members are afraid and fearful about what the healthcare system will ‘do to them’ because they have heard through the grapevine about others with bad experiences, like being ignored and dismissed when seeking care.
Dr. Enekwechi says the second differentiator is their insistence on building relationships with doctors and care teams. Traditionally, the support services during pregnancy are disconnected from the clinical services, leaving patients to navigate on their own using a pamphlet, the Internet or a list of numbers to call to find help. In contrast, Cayaba Care bridges this information and support gap, creating peace of mind for the mother. Also, rather than acquiring physical spaces, they seek to co-locate within provider offices, further building trust and collaboration with care teams. Enekwechi offered an example that is instructive for healthcare teams about SDOH screening. She says some people may feel too proud or ashamed to admit food insecurity to a doctor, but these vulnerabilities are readily shared with the right navigator. Thus, the navigator can also serve as a communication bridge to help ensure the accuracy of information provided to care teams.
After my conversation with Dr. Enekwechi, I was intrigued but remained skeptical. I wanted to hear directly from people who had received services from Cayaba Care. I spoke to three women, all of whom were black women and recently postpartum. They all agreed that Cayaba Care eased their pregnancy journey. Two of them had previous pregnancies with different complications, and both felt Cayaba Care made a difference in how they progressed through the pregnancy.
Jasmine, a 35-year-old mother who had recently delivered her third child, said, “During my other pregnancies, I had to do everything myself, so I loved that I could call them 24/7 and someone I trusted would answer.” She developed high blood pressure during her pregnancy, and the team supported her by providing information on the impact of blood pressure on her pregnancy, what to look for and when to seek help. This is critical, real time support since one of the most common contributors to preventable morbidity in pregnancy is heart disease-related conditions like hypertension. She also said, “Sometimes, it just helps to know you have support even if you only have a question and it is not an emergency.”
Rasheeda G. recently delivered twins and also praised the Cayaba Care team. She felt the differentiator for Cayaba Care compared to her previous pregnancy was that the person assigned to support her was also a Black mother with a similar background. She immediately felt comfortable with her, as if she were being cared for by a friend.
“There are some things you don’t want to ask the doctor or talk to them about because they might not understand or judge you. I can say anything to her,” Rasheeda said. She also noted her navigator taught her to self-advocate and emphasized that “Black women’s concerns are not taken seriously.” In a previous pregnancy, Rasheeda raised concerns about her history of anemia, but this was not addressed until her third trimester when she started experiencing symptoms. She believes that when a Cayaba team member accompanied her to visits, her concerns were taken more seriously, and she plans to use her new self-advocacy skills for all future healthcare engagements.
Speaking to Rasheeda provided insight into why maternal health disparities persist. Her experiences with Cayaba Care emphasized the importance of connection and qualitative aspects of care, which are often overlooked in evaluating maternal morbidity and mortality. While clinical factors like mental health conditions, cardiovascular issues, and infections are key contributors to morbidity, the underlying qualitative aspects are often ignored. Could having a trusted support system have prevented complications or fatalities? How do we assess the need for this kind of support?
Our current approach to maternal health in the US is predominantly clinical and quantitative, focusing on protocols, metrics, and predictors like blood pressure readings and blood counts. While important, Rasheeda’s experience highlights the significance of feeling cared for, building trust, and gaining self-confidence through interactions with healthcare providers. These qualitative elements are not consistently measured or addressed during pregnancy, and there is no systematic framework for incorporating them into healthcare delivery.
Reflecting on Rasheeda’s story, I am more optimistic about Cayaba Care’s potential to reduce maternal health disparities. Their human-first approach, centered on deep listening and establishing trust, has shown promising results in terms of cost savings and patient satisfaction. Dr. Enekwechi emphasizes the need for humility and openness in scaling this approach, recognizing that the healthcare system is currently limited in its ability to provide holistic support.
Embracing humility and prioritizing the human elements of maternal care delivery could lead to significant progress in addressing maternal health disparities. While immediate scalability may be a challenge, the replicability of Cayaba Care’s model nationwide offers actionable insights for policymakers and a pathway to achieving maternal health equity. By following Cayaba Care’s example of slowing down, listening, building trust, and tailoring support to individual needs, organizations can contribute to improving maternal health outcomes in the long run.
