In the journey to achieving maternal health equity, the voices and experiences of birthing people and families impacted by these disparities are our most powerful catalysts for change. Despite navigating the painful realities of inequities in maternal health, they remain underrepresented in shaping solutions. It’s time to rewrite this narrative. The Alliance was thrilled to learn from Elephant Circle about some best practices and approaches to community-driven solutions to address disparities in maternal morbidity and mortality.
Missed it? Read on for detailed readout, or access the recording and slides below.
The Alliance’s Jacy Montoya Price welcomed everyone with the hope that the conversation with Elephant Circle would inspire listeners to lift up community-driven solutions to maternal health inequities. She referenced the Alliance’s Theory of Change, which calls for the building of a durable constituency for change – and community members with lived experience are a crucial element of that durable constituency.
Jacy then turned things over to the panel of experts.
What and Who is Elephant Circle?
After Lauren welcomed and Pia led the group in a grounding exercise, Indra shared a bit about the founding of Elephant Circle. The name was inspired by how elephants birth in the wild – the whole herd circles the laboring mother, stays for the duration of the birth, and provides protection and defense. These are the same things humans need. Indra shared that Elephant Circle started as a problem-solving organization, hearing about and responding to challenges people were facing in the perinatal period.
George, a community advocate involved with Elephant Circle, shared what and who Elephant Circle is. They lead with an intersectional, feminist, reproductive justice, design-thinking approach to birth justice. This approach helps them push back against status quo power dynamics, making transformation possible. They are birth workers and advocates. They are committed to doing the emotional “heart work” – working with people who have faced inequities and harms in their birth experiences.
Passing the Birth Equity Package in Colorado
Indra shared that in Colorado in 2021, there was an opportunity to develop a set of bills to respond to the crisis in perinatal inequities in the state. Working closely with community partners, Elephant Circle coordinated the effort that became the successful passage of the Birth Equity Package. Core elements included on the policy side were a focus on human rights, improving data and systems, and encouraging innovation and quality control. Just as critical as the “what,” however, was the “how” they got the bills passed. Ensuring that directly-impacted people were involved at every stage helped change the power dynamics at play.
George shared how he came to the conclusion that birth equity is about each of us and was able to carry that message. As a parent of two, a parent advocate, and an early childhood development advocate, he already knew how critical it is to start at the beginning to ensure lifelong health and wellbeing. But at first he wasn’t familiar with birth equity and reproductive justice – and it didn’t sound like something that, as a male, he needed to be involved in. But as he listened and asked questions and studied the issue on his own, he realized he was exactly where he needed to be – that fathers, and all of us, need to be engaged. Now when people say “What do you know about birth equity – shouldn’t you be talking about sports?” he has plenty to share with them. He says while change is too often attempted by pruning leaves, birth equity and reproductive justice starts at the roots.
Implementing the New Laws and Continuing to Work Together
Indra shared that once the bills were passed, implementation of the new laws felt like an even more daunting task – getting multiple agencies on board with a new way of thinking and new policies. They took inspiration from the book Emergent Strategy and from the natural world – specifically, murmuration: when a species acts together in a coordinated way and direction. They chose to lean into the relationships and trust in each other that had helped get the bills passed despite challenges, and they continued to attune themselves to each other.
Lauren shared that as a result, the implementation group has continued to meet and grow and search for community-based solutions to maternal health issues. They intentionally create a joy-filled space and “meet the community where they’re at” – an organizer phrase meaning they go physically but also psychologically and emotionally where the community needs them to go.
Lauren and Pia shared that the group is currently working to get Medicaid reimbursement for doula services, and that work is a great example of murmuration working:
- The group listened and responded to a need that some of their members – birth workers – had been calling for for a long time
- Because they already trusted each other and had worked together, they were able to quickly activate. They were already a herd and could move as one.
- They were able to do quick work to ascertain where people were and what they needed them to do – like doing education, answering questions, sharing more about what this could look like in Colorado, and combatting imposter syndrome and lifting up lived experience as valuable.
- They created multiple opportunities for people to engage from wherever they sat – for example, those in rural communities were having vastly different experiences from those in urban areas.
- They traveled together 1200 miles across the state doing trainings and listening and learning from people’s birth stories and what they said they needed. That led to a landscape analysis and an effort to learn from and contribute to the birth justice movement nationally, as well as the kick off of People’s Tribunals: starting in NYC and Memphis, community members will share their stories, helping to highlight why we need strategic solutions.
Deep Listening in Action
Indra and the team modeled deep listening and murmuration to demonstrate how to work this way, especially if you don’t already have a culture in your organization of meeting people where they’re at. Indra asked the question: What was your favorite story as a child? George, Lauren, Pia and Indra all responded with a story and shared why it was important to them. Indra then highlighted how engaging in a question like that puts us into a certain mindset:
- We were all immediately curious about which stories they were going to mention, because we had no way to know what they were going to say. Curiosity puts us in a generative, creative space.
- The open-ended, somewhat random nature of the question forced us to focus on the process rather than the product, because a conversation about favorite childhood stories is not directly connected to birth equity!
Indra then invited webinar attendees to participate in a multiple-choice poll, listing 6 children’s books and asking attendees to mark their favorite children’s book. Many people on the call couldn’t participate, because the limited options they were offered didn’t work for them. Indra used this to point out that if you give people a limited box to work within, it doesn’t feel like you really want to be in relationship or that you value what they are offering. The short list of book choices contrasted sharply with the open-ended way they had discussed their favorite books during the prior conversation. When we offer people only a limited set of options, and then act on the information we receive, we can send our advocacy off in a direction that may not actually meet people’s needs.
Best Practices in Lifting up Community-Driven Solutions
Finally Lauren shared some do’s and don’ts when it comes to lifting up community solutions.
- Do start with relationship building. Value process over product and connect with people over even small things. Don’t engage in ways that are extractive (“We need someone to share their story…”), which doesn’t build long term power or support the community to be able to drive forward solutions.
- Do center lived experience as much as or more than other expertise. Don’t center credentials or position – you don’t have to have a degree or be a lobbyist to talk about your life and engage in policy change.
- Do reject the status quo and embrace innovation and uncertainty. Directly-impacted people often see things differently from policy professionals – embrace that they don’t automatically fall into what’s expected under what can be an oppressive status quo. Create spaces where people can feel safe to “fail fast, learn fast.”
- Do meet people where they’re at. Don’t remain stagnant by staying just at the capitol or just in your area of the state. Get to know other perspectives.
Poetry and Inspiration
George, valued by his teammates as their poet laureate, wrapped up the webinar by reminding us not to let the head stop the passion of the heart. People can get together and make a plan and then be out-maneuvered by another mind, but a dedicated group of people can’t be “out-hearted.” Let the pain people are feeling and their passion fuel us all to come up with ideas that haven’t been imagined yet.
Attendees were invited to participate in one more quick activity:
Can you talk about your work outside Colorado?
- Working with Birth Detroit to replicate the birth equity package in Michigan, the “Michigan Momnibus.”
- Currently planning People’s Tribunals with 30 or so organizations and will hear from people all over the country who have lived experience with acute harm in the perinatal period.
- Elephant Circle is now part of the Alliance for Early Success network and can work with our state allies directly.
Several questions brought in the reality of politics – adapting messages and strategies for conservative policymaker audiences while staying authentic to the experience of directly-impacted people. The team gave some advice:
- Build relationships, which can get us to common ground. Listen to understand others’ concerns and needs. Ask questions that get to the core of what they care about and what their values are. If you listen in a genuine way, people will tell you things about their lives.
- This is an issue of the heart, humanity. We have all been birthed and many of us will give birth. Speak to the humanity of the issue and what we all have in common. There are so many examples of challenging birth stories across party lines.
- Highlight the realities of birthing injustice in rural areas which are often maternity health care deserts. Rural legislators often have these concerns.
- Offer a wide menu of options. With a narrow menu of options, people get dug in and paralyzed. Innovation and growing the spectrum of ideas means there may not be a pre-existing opposition, and we may find new allies through a new idea.
- Feel free to avoid specific words if they don’t go over well. Indra says “We’re not precious about the words, we’re precious about the heart.”
- Conservative legislators often value pregnancy, people giving birth, and maternal health. Start there.
- Talk about family values. These are family issues, not just women’s issues.
- Test and innovate. See what works. “Fail fast, learn fast.”
- Most importantly: Listen to folks in the community – they’ll tell you how to do this well.
Jacy closed the webinar out with an invitation to join future National Issues>State Action webinars, including two more maternal health webinars on supporting the perinatal workforce and on maternal mental health supports.
Colorado Birth Equity Bill Package: https://amchp.org/database_entry/colorado-birth-equity-bill-package/
More on Landscape Analysis: https://www.elephantcircle.net/landscapeanalysis
More on People’s Tribunal: https://www.elephantcircle.net/peoplestribunal
What is “Community-Based?” https://www.elephantcircle.net/s/What-is-community-based.pdf
¿Qué significa “basado en la comunidad”? https://www.elephantcircle.net/s/Whatiscommunity-based_SPA.pdf
More about BESO: https://www.canva.com/design/DAFhDOO8iAM/tQrex7-MvlYUMK0K2gY0ZA/view
National Association of Counties Maternal Care Access Map: https://ce.naco.org/?dset=Maternity%20Care%20Access&ind=Maternity%20Care%20Access
The Elephant Circle map: https://www.elephantcircle.net/our-model