In Southwest Virginia, Reestablishing a Rural Hospital System Requires Rebuilding Trust

Mobility for Africa provides electric tricycles, called Hambas, to take pregnant women to and from health appointments. Mobility is critical to reduce maternal and neonatal mortality and the three-wheel tricycles are easy to drive on rural roads. They run on a lithium battery that can be charged in about six hours using renewable energy and a single charge gets about three trips. The transportation allows women who live far from clinics and cannot afford transportation be able to access medical care. About 50 Hambas currently take women to and from doctor appointments during pregnancy until after delivery.

Project CARA (Care that Advocates Respect/Resilience/Recovery for All) supports pregnant and parenting people with substance use disorders, providing healthcare, addiction resources and obstetrics care in one spot. The program's hub-and-spokes model makes care more accessible, especially for those in remote areas. Data from the Project also indicates that participants of the program are more likely to attend prenatal and postpartum appointments than those outside of the program.

Traditional birth attendants provide maternal care to women in hard to reach areas. With government help through the Mama2Mama program, several TBAs are undergoing training to provide safer, more effective maternal care.

The Abiye Project registered over 20,000 pregnant women using a community-based model to ensure they receive proper healthcare. The program connected women with trained health rangers who served as liaisons with traditional birth attendants (TBAs). When TBAs’ resistance stalled the program, the government introduced financial incentives, paying them for each patient referral, leading to more hospital births and a reduced child and maternal mortality rate.

Six programs throughout the state, including the SUN Project and Project CARA, are working to provide support to pregnant mothers navigating a substance use disorder. With support from the North Carolina Perinatal Substance Use Disorder Network, the programs share best practices for treating perinatal substance use and expand access to treatment. Project CARA alone serves more than 200 patients each year.

The Olympia Bupe Clinic's walk-in model for treating opioid addiction allows patients to receive medication-assisted treatment with buprenorphine on their first visit without barriers or extensive wait times. This low-barrier approach eliminates the hurdles people often face when seeking treatment. The Clinic also hires staff with lived experience with addiction to build trust and community with patients.

Doulas are becoming a more widely used resource among pregnant people, particularly Black women who historically face racial inequities during pregnancy and childbirth. Groups like The Doula Network and the Southern Birth Justice Network are working to expand doula services by training and connecting pregnant women with certified doulas. Doula care is more holistic and studies show that women using doulas have about a 65% reduction in their odds of developing postpartum depression or anxiety when a doula is present during labor and delivery.

In an effort to combat high rates of maternal mortality and healthcare disparities among pregnant Black women, MLK Community Hospital offers combined care from certified nurse midwives and obstetricians to ensure a safe, healthy birth. Midwifery offers more sensitive and individualized care and is also linked to fewer C-sections and preterm births. At MLK Community Hospital, 14% of its first-time, low-risk births involved a C-section, compared to 23% of such births across the state.

The Women-Inspired Neighborhood (WIN) Network: Detroit works to improve Black infant health outcomes by providing support services like group prenatal care, targeted home visits, and breastfeeding programs. By using the CenteringPregancy model, over 600 women have gone through the program and there have been zero preventable infant deaths. Win also helps direct women toward resources like stable housing and higher education.

The Center for Human Rights and Civic Education launched an outreach program that aims to improve maternal and child healthcare by spreading information on the importance of antenatal sessions and care. The nonprofit also has a weekly radio program to further spread information about this important care. The program started in 2017 and has since held 28 outreach events with healthcare providers and community members.