Standing outside the Nurture KC office in Westport, Marcela Metcalf is preparing to greet 25 families with newborn babies.
She and fellow Kansas City community health workers have bags of produce and some diapers prepared for each family as part of a temporary collaboration between University Health and Nurture KC, a non-profit focused on improving the health of mothers and children. Metcalf is a lead community health worker for Nurture KC.
As a mother parks her car and approaches the back entrance to the office, carrying her newborn daughter, Metcalf closes the distance to greet the mom and meet the baby. The bag includes mangos, strawberries, and baby carrots this time.
Metcalf said she was always drawn to working with mothers. After studying social work in Ecuador, Metcalf worked as a medical interpreter and bilingual family support in Tulsa, Oklahoma. Almost six years ago, Metcalf relocated to join Nurture KC.
She immediately noticed expecting or new mothers and their babies face many barriers.
“The big, big problem I see is transportation to go to appointments,” she said. “I also see a lack of healthcare. People are really, really struggling to get healthcare right now, especially women that come from other countries.”
Both Missouri and Kansas struggle with poor birth outcomes compared to most of the country.
Between 2018 and 2020, Missouri had the 12th highest maternal mortality rate in the country, and Kansas had the 17th highest, according to the Kaiser Family Foundation. In 2020, Kansas had the 12th highest infant mortality rate and Missouri the 19th highest, according to the CDC.
Mothers in Wyandotte County die at a rate of 83.5 per 10,000 live births — compared to the state average of 61.9.
In the March of Dimes' latest report card on preterm birth rates, Missouri got a D-, which was the 16th worst grade in the nation. Jackson County, Missouri, received an F. Both are below the national grade of D+.
Marvia Jones is the director of the Kansas City Missouri Health Department. Jones is particularly concerned that mortality and morbidity rates for white women are improving in Kansas City but the rates for women of color, especially Black women, are not.
Jones points to high hospitalization rates, more complications during the birthing process and declines in mental health.
“We can see that not only is poor maternal health a factor of just kind of whatever's happening once these women show up at the hospital, but we're also seeing that it must be connected to broader social structures as well,” Jones said. “There's something about the environment and the living situations of these folks and that leads us to more social determinants of health concerns.”
Jones said Black mothers often report feeling disrespected or ignored by medical professionals during their pregnancy. If a mother is mistreated, Jones said it puts them at higher risk for postpartum depression.
That’s where groups like Nurture KC try to meet the community where they’re at. Nurture KC focuses on 14 metro-area zip codes with the highest rates of infant mortality.
The Missouri zip codes are 6109, 64111, 62124, 64126, 64127, 64128, 64130 and 64132 — and 66101, 66102, 66104, 66105, 66106 and 66111 in Kansas.
Metcalf met recently with an expecting mother from one of those zip codes, who she’ll continue to work with until her baby is 1.5 years old as part of their federally-granted Healthy Start program. Nurture KC is one of 101 such programs across the country and one of two in Missouri, the other working in the bootheel.
Metcalf and the mother went over safe sleep instructions.
Sudden infant death syndrome, or SIDS, is the unexplained death of an infant under 1. The syndrome is also sometimes called crib death, because it occurs while the baby is sleeping and is the leading cause of death for babies 1 month to 1 year of age.
Metcalf said sleep-related deaths are particularly disheartening because most can be prevented with education and outreach, like reminding a mother to keep the crib empty or lay the baby on their back.
Now it’s her mission to make sure more moms know recommended practices.
“If you cannot come over, I'll go to your house and do a home visit,” Metcalf said. “The most important thing is just to convey the information and the education.”
After they complete safe sleep instruction, mothers leave with a crib and car seat for their baby. Expecting and new mothers can also earn points by attending appointments they can then redeem for other useful baby-related items.
Metcalf is one of seven community health workers who each work with 25 to 40 families. Nurture KC Executive Director Tracy Russell said the community health worker model is critical to their success.
“Those community health workers establish those personal one-on-one relationships,” Russell said. “They become very trusted advocates for the moms they're serving and those children.”
Their work with mothers can range from education to helping them access health care or housing.
The community health workers at Nurture KC are also training to be doulas, professionals who may provide guidance and support before, during and after delivery.
Hakima Payne is the executive director of Uzazi Village, a nonprofit working to improve infant and maternal health in Black and Brown communities. It has eight culturally-congruent doulas on staff who reflect — and sometimes grew up in — the communities they serve. She recommends that clients choose home births or birth centers if they qualify.
“The current healthcare system fails us as Black women, and until the system chooses to reform itself, then it's our contention that Black women would do better to step outside the system for their care,” Payne said.
Over the past 10 years, 15% of Uzazi Village’s clients gave birth outside a hospital: 9% at birth centers accompanied by a doula and 6% at home with a midwife and a doula. Payne said this shows efforts to educate mothers about their options are working.
The data also demonstrated improved outcomes for mothers who used Uzazi Village’s doula services. But for many, doula services are too expensive. Some states offer to reimburse these services through Medicaid, but Missouri is not among them.
Payne believes every state will pass legislation to provide easier access to what she called a cost-effective method to increase positive health outcomes for mothers and their babies. She said a focus on culturally-competent doulas that reflect the communities they serve would decrease racial disparities.
“Cultural congruency is what we think is the key piece that's missing,” Payne said. “Our doulas are trained to be really knowledgeable about the health care system and its gaps because our doulas are intended to stand in those gaps and meet client needs where the current hospital system just doesn't.”
While Payne is optimistic about laws supporting doula services, she has concerns about the bigger picture. The Missouri Legislature is trying to prevent anti-racism training for health care providers, which could make it harder to improve birth outcomes for Black and brown babies and their parents.
“(Anti-racism training) is exactly the thing I would put number one on the list to improve things for Black childbearing people,” Payne said, “Even when people are sincere and recognize that there's a problem and do a lot of hand wringing, they don't really know what to do about it.”
