A Labor of Love

This kind of exchange is not uncommon for the relationships cultivated by McFarlane and the six women who work alongside her. As trained maternal and child health educators, they guide and support new and expectant families in San Diego County through the uniquely challenging and personal experience of pregnancy and postpartum.

To them, this is more than a job; it’s a quest to sustain life.

Many of their program participants — primarily Black women — are nearly three times more likely than white women to die from pregnancy-related complications.

The National Institutes of Health highlights that adverse maternal health outcomes for Black women are significantly influenced by systemic racism within the health care system. Disturbingly, over 80% of pregnancy-related deaths are preventable. Factors such as implicit bias, a widespread lack of understanding of health impacts on Black individuals, disparities in care standards, and toxic stress make navigating the health care system a life-threatening ordeal for many pregnant Black women. Such inequities leave many traumatized and distrustful of health care institutions. In response to these alarming statistics and the urgent need for health care policy reform, Global Communities designed its Healthy Start program to address gaps in care and support.

Founded in 2007, Global Communities’ Healthy Start program (“Healthy Start”) aims to improve health outcomes before, during and after pregnancy and reduce disparities in infant death and adverse perinatal outcomes. Since its inception, the program has provided maternal and child health services and education to over 6,000 mothers, fathers, babies and same-sex partners.

Funded by the U.S. Health Resources and Services Administration, Healthy Start employs a client-centered approach to deliver lifesaving care such as prenatal and childbirth education, postpartum assistance and breastfeeding support, prioritizing Black families and immigrant communities in San Diego County. Participants also have access to midwifery and doula services, among other resources.

While these services may seem basic to some, they are transformative for the communities served by the program. With the support of Perinatal Navigators, the program has achieved significant milestones in advancing the health and well-being of families in San Diego.

In 2023 alone, the dedicated team completed over 2,600 home and telehealth visits, a meticulous process where Perinatal Navigators ensure participants have access to essential education, resources and tools vital for their newborns' well-being.

Lisa Bain, Senior Director of Global Communities’ U.S. Programs, describes the unique bond between Perinatal Navigators and participants that sets Healthy Start apart in San Diego.

"In most health care settings, a person goes to a medical office and will be seen by whoever is available. In our model, we go to the homes of our families, and the same person provides support from pregnancy well into postpartum," Bain says. "That consistency and that long-term relationship form the basis of the comfort and the trust that then allow us to achieve better health outcomes."

Charles, a Perinatal Navigator who works with military families, highlights the importance of staying abreast of resources specifically available to this demographic to serve them more effectively. For example, she can connect them with a military-focused doula service or lean into conversations about deployment and being away from family.

Meanwhile, Perinatal Navigators working with participants who are refugees and asylum seekers have identified the need for free legal services, as many clients juggle complex immigration paperwork and hearings while pregnant or postpartum.

To better address structural issues like this, Healthy Start collaborates with a variety of entities and programs outside of Global Communities to offer resources beyond what Perinatal Navigators can provide directly. These partnerships introduce participants to a network of community-based organizations dedicated to uplifting immigrant and minority experiences in San Diego.

For example, Healthy Start directly contracts with midwives, lactation clinicians and mental health providers as a first step to ensuring the full range of family needs are met.

Given the variety of challenges many participants face, Perinatal Navigators must be well-connected within the community to ably guide them through complex resource systems that can improve their lives and those of their children.

As language barriers can often impede care, the program has made extensive efforts to provide translation services for participants who are not proficient in English. To date, the program employs staff members who speak Spanish, Somali, Arabic, Haitian Creole and Farsi/Dari, with 58% of health workers in the program being bilingual. This linguistic diversity ensures participants can communicate in their preferred language, fostering a sense of safety and understanding.

Perinatal Navigators are often integral parts of the communities they serve, frequenting many of the same establishments as their participants such as community centers, places of worship and ethnic grocery stores.

This can be a particularly important sentiment given the sensitive nature of maternal experiences for many participants. Beyond shared identity, most program staff are also mothers who have navigated the U.S. maternal health care system themselves, allowing them to offer firsthand accounts.

Shared religious experiences are also crucial in the Healthy Start program. Serving many refugees and immigrants from Muslim-majority countries, it is vital that Perinatal Navigators understand the specific religious concerns of their participants. This understanding can make the difference between a successful health care visit or a traumatic encounter. Given the history of Islamophobia in the United States, many Muslims distrust American institutions, including health care.

For example, some Muslim program participants prefer female doctors for hospital visits, and Perinatal Navigators advocate to ensure preferences like this are articulated and respected. This level of support provides participants with peace of mind, knowing that someone who understands their religious concerns is supporting them. Perinatal Navigators help bridge cultural understanding between health care providers and participants.

The diversity of participants in Global Communities’ Healthy Start program reflects broader global trends and events, serving as a microcosm of worldwide immigration patterns and political shifts. The International Rescue Committee notes that the fall of Saigon in 1975 marked the first major wave of immigration into San Diego County followed by various ethnic groups making it their home in subsequent decades.

From the 1980s through the 1990s, refugees from Iraq, Somalia and other countries sought refuge in the area due to civil unrest in their homelands, making City Heights a hub for refugee resettlement and resources and opening the door for further immigration. In an interview with KPBS, a community member describes the area's diversity as “a cultural mash-up where Somali women in headscarves and Burmese women holding parasols stroll past Vietnamese supermarkets and Pagoda-style strip malls.” More than 30 languages and 80 dialects are spoken in the City Heights neighborhood alone.

When the Taliban assumed control of the Afghan government in 2021, San Diego once again saw an influx of refugees, profoundly impacting Global Communities’ Healthy Start program. The team swiftly acknowledged a significant rise in demand for services within the burgeoning Afghan community. Consequently, the program recruited interpreters proficient in Pashto and Dari to facilitate effective communication with Afghan participants.

“We didn't anticipate a surge of asylum seekers from Afghanistan, much like we experienced with Haiti. It wasn't initially part of our program's scope, but people began reaching out and asking for help despite language barriers,” Bain says.

This led to greater outreach to the wider Afghan community and a better understanding of how Healthy Start could help address their needs related to maternal and child health.

"We started learning about the Afghan community, including their documented challenges with the highest infant mortality rates worldwide. Here we are, a program designed to address infant mortality disparities,” Bain says.

Whether vulnerable Afghan families or another demographic new to San Diego, Healthy Start’s adaptability has been crucial to ensuring the program can proactively respond to unforeseen global developments and provide effective support to expectant families.