Skip to content


Women-led Birth Equity Work

This story originally appeared in the Grantmakers in Health blog, Views from the Field, on March 14, 2022. See the original post here.

Central Texas offers a variety of maternity services and maternity care—if you are well-insured or can pay out of pocket. For the uninsured and underinsured, maternity care options dramatically shrink.

In early 2021, St. David’s Foundation awarded $1.8 million to 12 projects supporting programs aimed at reducing maternal mortality, improving mental health, facilitating health insurance coverage, advancing access to family planning and reproductive care, and initiating breastfeeding—projects that will transform our region of Central Texas into a Perinatal Safe Zone. The work of this initiative recognizes, listens to, and centers women of color who disproportionately experience poor maternal health outcomes. This effort reflects our foundation’s journey over the past few years, carried forward by a team of women leaders committed to reimagining the way we work and how we show up within the communities we serve.

The vision and strategy for this work emerged in 2016  and included multiple convenings, listening sessions, and one-on-one meetings with women leaders in Central Texas. One of those convenings featured the work of Jennie Joseph, who leads the National Perinatal Task Force (NPTF). Jennie and the NPTF team coined the term Materno-Toxic Areas (any area where it feels unsafe to be pregnant, breastfeeding, or parenting), and developed their signature Perinatal Safe Spots.

The work of the NPTF inspired an idea: if we work together to increase the number of perinatal safe spots in our region, igniters, contributors, and allies to maternal health can collectively eliminate materno-toxic areas. We started small. In 2017, St. David’s Foundation issued a request for proposal (RFP), Focus on the Fourth, which prioritized the postpartum period, or the “fourth trimester.” For many organizations, particularly those led by women of color in Central Texas, this call for proposals served as the first opportunity to apply for funding from St. David’s Foundation. Prior to this, organizations needed an invitation to apply, creating an unintentional barrier for organizations that did not have direct relationships with program officers.

As a result, awards for the Focus on the Fourth initiative went to new organizations and supported project types the foundation had not previously funded.  One grantee, Mama Sana Vibrant Woman, instituted a structured postpartum program with home visiting, support groups, and yoga for moms of color. Another grantee, Hand to Hold, diversified its peer mentor base and board of directors, conducted focus groups with neonatal intensive care unit (NICU) mothers of color to inform programming, and developed marketing campaigns that resonated with this population.

As statewide stay-at-home orders were issued due to the COVID-19 pandemic in 2020, organizations serving pregnant people in Central Texas came together to form the Maternal Health Equity Collaborative (MHEC), which included three original grantees from the Focus on the Fourth initiative. While the collaborative was initially created out of necessity to better serve pregnant people during this unprecedented time, MHEC gave leaders the opportunity to pause, regroup, and align work across their organizations. The resulting  analysis from this group on the state of the health of pregnant families of color, summarized by MHEC in the report titled The Spirit of Possibility, gave direction to the foundation’s next RFP: Perinatal Safe Zone: Supporting Healthier Pregnancies Together, issued in the summer of 2021.

The Perinatal Safe Zone is not a departure from the strategy set forth in the foundation’s Healthy Women and Girls strategy area, but rather the next logical step in deepening and homing in on the foundation’s work toward a shared goal with our grantees and community partners. In response to The Spirit of Possibility report, we have expanded our focus on the entire spectrum of the perinatal period while also thinking about the community conditions that are needed to support healthier pregnancies.

The learning collaborative that accompanies the grants under the Perinatal Safe Zone RFP is open to both grantees and non-grantees who want to contribute to building a Perinatal Safe Zone. This new community of practice welcomes other nonprofits, businesses, employers, and clinical providers to participate as well.

We believe that creating a Perinatal Safe Zone will require multisector mobilization at the regional level. A mobilization at this level will require participation from hospitals, legislators, and state agencies, while centering Black and Brown led organizations and leaders working to achieve stable and affordable quality housing; welcoming, flexible, and equitable workspaces, with paid parental leave and universal child care services; a just food system; safe and walkable neighborhoods; a caring and supportive network of community members; and access to holistic and culturally congruent wellness practices. We are eager to include any organization, institution, or community resource that touches the life of childbearing people to help create the community conditions that support the pregnant person before, during, and after birth.

To achieve buy-in of the Perinatal Safe Zone concept, we need to make room for:

  • people who are already contributing to share how they are doing so;
  • people who have not thought about how they can contribute to imagine what their contribution could look like; and
  • people who are not familiar with the concept to learn what it is and decide to do something about it.

This will take:

  • clear messaging and close collaboration with the foundation’s communications team;
  • growing our networks and deepening relationships by building a big table and forming new kinds of partnerships with various organizations;
  • showing up as our full selves and collaborating authentically with a strengths-based perspective, moving at the speed of trust;
  • trainings like the ones that the National Perinatal Task Force will conduct through our learning collaborative; and
  • Access to long-term, nonrestrictive funding opportunities that support the development of this work.

We are excited for this new phase of our work and for our partnership with the NPFT, the MHEC, and other grantees. If you are not already working in close partnership with leaders representing the constituents you serve, we invite you to start today, and to begin to imagine how to create the conditions that support equitable birth outcomes in your community.

Learn more about the Perinatal Safe Zone initiative >