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. “You know 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,” she said. Rasheeda also noted her navigator taught her to self-advocate and said, “Black women’s concerns are not taken seriously.” In a previous pregnancy, Rasheeda raised concerns about her history of anemia but this was not acted upon until her third trimester when she became symptomatic. She says that when a Cayaba team member accompanied her to visits, she believes her concerns were taken more seriously and plans to use her new self-advocacy skills for all future healthcare engagement.
As I spoke to Rasheeda, her examples provided a bit of sunlight to help me better understand why we are not reducing maternal health disparities. Her experiences with Cayaba Care were not about something clinical and quantitative but about connection, something qualitative. These qualitative differences are likely dismissed when evaluating causes of morbidity and mortality. For instance, the top reasons for preventable maternal morbidity are mental health condition, cardiovascular and infection. We categorize these things but have no context to understand what led to these diagnosis codes. Could a complication or fatality been avoided by have someone trusted to call? How do we assess whether or not people need this kind of support?
Our approach to maternal health in the US is largely clinical and quantitative, focused primarily on protocols, clinical metrics and clinical predictors like a blood pressure reading or a blood count. These are important, but Rasheeda described feelings of being cared for, trust, and self-confidence bestowed by a Cayaba Care team member. We do not actively and consistently measure or intervene on these during pregnancy. In fact, we have no framework for applying this systemically across healthcare teams in the US.
In reflection, I am much less skeptical about Cayaba Care’s ability to reduce maternal disparities among those they touch. They already have early signals their approach is saving money. The human-first approach they employ incorporates deep listening and connection with a trusted source of support, which is of high value to patients and to the healthcare system. Dr. Enekwechi also says, “The healthcare system is too constrained to help people. We can help close the gap but we have to remember the most important requirement in scaling our work is a heavy dose of humility and assuming you don’t know.”
If each organization embraces this humility and openness to the human elements of maternal care delivery, we will likely be much more successful in addressing maternal health disparities.
Even if this approach is not immediately scalable, it is certainly replicable nationwide, provides actionable recommendations for health policymakers and highlights a path to achieving maternal health equity. This will require organizations to emulate Cayaba Care’s efforts to slow down, listen, build trust and tailor support to each person’s needs. Maybe then, in another 20 years, we will finally see dramatic shifts in our shamefully embarrassing maternal health outcomes.
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