As Numbers Trend in the Wrong Direction, This Foundation's Focusing on Maternal Health
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Foundation grantee 18 Reasons tackles food insecurity for pregnant and new mothers. Image courtesy of 18 Reasons.
A recent Fortune commentary featured this blunt headline: “U.S. maternal deaths have nearly doubled in just three years — and no one seems to care.”
The headline underscores a confounding reality: Even though it’s one of the wealthiest nations on the globe, the U.S. is one of the riskiest places to have a baby in the developed world. And the numbers are trending in the wrong direction, according to the March of Dimes, which found that the U.S. preterm birth rate increased to 10.5% in 2021, a 4% increase in one year and the highest recorded since 2007.
Black women are at highest risk: Their maternal mortality rates are close to three times as high as for white women. The Supreme Court’s reversal of Roe v. Wade last year appears to be making matters worse. Women living in states that banned abortion after the decision were up to three times as likely to die during pregnancy or childbirth, or soon after giving birth, according to a report by the Gender Equity Policy Institute.
The Elevance Health Foundation is paying attention to this crisis, and has committed to investing $30 million by the end of 2024 in an array of programs that promote equity in maternal healthcare. To date, the foundation has funded 26 programs around the country.
The foundation has tracked some small but significant progress: As of this May, 474 babies have been born to women served by programs funded in the foundation’s initial 2022 round of grants, of which 445 were full term — a 6.1% preterm birth rate, which is lower than the national average of 10.5%. But there’s clearly a tremendous need for greater philanthropic investment in this space, particularly as it intersects with the need for more racially just health outcomes across the board.
High-touch — and why it matters
Elevance Health Foundation, formerly known as the Anthem Foundation, is the philanthropic arm of Elevance Health (formerly Anthem). The name change, adopted last year, was a rebrand, and didn’t signal any real changes at the organization, according to foundation President Lance Chrisman. In 2021, however, a six-month internal evaluation of the foundation's work led to what Chrisman called a “strategic refresh” of its priorities. An internal strategy team determined that the foundation was trying to take on too many issues and spreading itself too thin. In response, the foundation decided to focus more closely on its priority areas, including maternal health. (Substance use disorder is another priority for the foundation, as my colleague Paul Karon wrote last year.)
“The category, maternal health — that's a pretty big range,” Chrisman said. “So we narrowed that down to reducing preterm birth rates and reducing maternal morbidity and mortality rates, and also reducing primary C-section rates. We're trying to do that with grants that encourage or help with access to care: high-touch, supportive care. Those are the most proven and impactful programs you can do. And we want to use the data to ensure that we are targeting the most socially vulnerable.”
By “high-touch,” Chrisman means consistent, often in-home care for pregnant and new mothers and their infants, doula programs that provide pregnancy, childbirth, and post-partum support and advocacy, and medical care that is comprehensive and culturally responsive.
Some examples of Elevance Health Foundation’s grantees include Urban Baby Beginnings, which provides health, doula and lactation care for pregnant and postpartum women, a program at the Morehouse School of Medicine to promote enhanced communication, bias reduction and improved maternal care in marginalized communities, and Creating Healthier Communities, which is developing a screening tool that can identify stress and other social drivers of health that are predictors of preterm birth. (See IP’s previous report on this foundation’s maternal health work on for more information on grantees.)
Nourishing Pregnancy
Among the foundation’s grantees is 18 Reasons, a nonprofit community cooking school based in San Francisco. 18 Reasons offers paid cooking classes, as well as free cooking classes and food donation programs for low-income families. The funding will support the school’s Nourishing Pregnancy program, which works to tackle food insecurity, promote healthy nutrition and build community for pregnant and new mothers.
Nourishing Pregnancy was launched in 2021 in response to trends in San Francisco, where 20% of Black and 27% of Latinx women experience food insecurity during pregnancy, compared to close to 0% for white women. Participants include mothers in their last trimester of pregnancy through their second month postpartum. Nourishing Pregnancy’s 16-week program provides online prenatal cooking, nutrition education and postpartum support classes. Participants receive free grocery deliveries and learn easy recipes using healthy, affordable ingredients.
“All of our recipes and our cooking approach is inclusive of everybody, no matter where they are on their cooking journey,” said Briana Tejuco, program director at 18 Reasons. “We welcome everybody from all backgrounds — whether you are an advanced cook or don’t know how to boil a pot of water. Everybody is welcome at our table.”
One of the goals of the program is to break down the isolation that pregnant women and new mothers so often experience and to build community. “We’re trying to create a space where folks feel like they're welcomed, they're supported, they're heard and they belong,” Tejuco said.
Nourishing Pregnancy has participants in Alameda and Contra Costa Counties, as well as San Francisco; a few families Zoom in from other parts of California. Tejuco is hoping to expand the program’s reach even farther in the future.
Some indications of the program’s impact: In 2022, 104 people participated in the Nourishing Pregnancy program, and 99 graduates (95%) had full-term births. One hundred percent of the graduates said they were satisfied with the program, 27% reported an increase in cooking confidence, 39% reported an increase in vegetable consumption and 14% reported an increase in food security.
Learning curve
18 Reasons and Elevance Health Foundation’s other grantees are showing results, but can these organizations, collectively, make a dent in the U.S. maternal mortality crisis? Lance Chrisman is both cautious and hopeful. “We aren’t pretending that we're coming in with all the answers,” he said. “We're learning as we do this, and we are tapping and partnering with some of the best nonprofits in the country that are dealing with these issues 24/365. And we're utilizing their subject matter expertise in the community as well to help address those needs.”
Experts agree that the maternal health crisis is driven in large part by systemic racism (a recent study showed that socioeconomic status doesn’t eliminate the higher risk Black mothers and their infants face compared to their white counterparts). Systemic racism is, of course, a deeply entrenched problem that doesn’t lend itself to easy fixes — particularly when so many powerful Americans, including prominent lawmakers and the current Supreme Court, refuse to acknowledge that it exists.
There is, however, a fair amount of consensus within philanthropy that attacking the upstream causes of problems like rising maternal mortality — systemic racism among them — is a promising avenue for funder dollars. In conjunction with direct support for mothers, including via community-based organizations, philanthropic support for broader changes to the inequitable systems those mothers face holds a lot of promise. But as long as mortality rates continue to rise and maternal health results remain so racially skewed, it’s clear that more and better support is necessary. Whether it’s the sort of “high-touch” direct services that Elevance Health Foundation backs, or a more upstream approach centering, say, health justice movement work, there’s great need for more philanthropic investment here.
In the meantime, funders like Elevance Health Foundation continue to do what they can to support efforts like 18 Reasons’ Nourishing Pregnancy program, aiming to improve the wellbeing of mothers and babies one family at a time.
Editor’s note: A previous version of this story referred to Nourishing Pregnancy as a grantee of Elevance Health Foundation. 18 Reasons is the organization that received that support.
