Beyond birthing: NYC expands free programs for moms through pregnancy and after   

BROOKLYN — As a new immigrant still learning English, Marie* had never heard the word “doula” before a hospital worker asked if she might like to have one during a prenatal visit. Unsure what it was, but certain that she could use help with her third pregnancy since her family was living in a shelter at the time, Marie agreed. And, she’s glad she did. 

Within days, a Haitian organization’s maternal health program contacted Marie and helped match her with a doula who speaks St. Lucian Creole. The doula was with Marie through the pregnancy, took her to the hospital in a taxi for the birth and stayed by her bedside for 14 hours through the delivery. After the birth, the doula briefly watched the other kids so Marie’s husband could see her and the newborn. For three months after, the doula visited to help the mom and baby adjust. 

“She became like a mother to me,” said Marie, who asked to use a pseudonym to protect her privacy. “Every time she came over, she took over with the baby and did everything for my baby – bathing, feeding, everything.”

“I truly appreciated all the service,” Marie added. “This program is a beautiful program.”

Marie’s doula is part of the Citywide Doula Initiative, one of several “New Family Home Visits Initiative” the city is expanding to support new and expectant parents. The city’s health officials say such community-based programs are one way they are addressing maternal health disparities, which have historically put Black families at the highest risk, particularly Haitians. 

Black women in New York City are five times more likely to experience severe complications or die from pregnancy-related causes than their white counterparts, according to Department of Health and Mental Hygiene Commissioner Dr. Alister Martin. To reduce maternal mortality, deaths occurring during or shortly after pregnancy, the city is expanding several initiatives it has implemented over the years in limited forms, such as the doula program.

“This is about meeting families where they are,” Deputy Commissioner Lidiya Lednyak said. “No one should feel like they have to navigate pregnancy or early parenthood alone.” 

Promising progress seen so far

Its Citywide Doula Initiative has brought promising results so far, officials say. Besides hands-on help, doulas often serve as advocates, helping patients navigate the health system and have their concerns addressed. Over a three-year evaluation period, the program recorded zero maternal deaths among its participants.

Another is the Newborn Home Visiting Program, which provides non-medical support before, during and after childbirth. A third is the Nurse-Family Partnership program, which assigns nurses to at-risk mothers early in pregnancy and continues regular visits through the child’s first two years of life.

Altogether, the programs aim to address medical needs, and factors in the families’ lives that influence maternal health, such as housing instability, nutrition and mental health. Overall, Martin explained, these social drivers of health — factors like access to housing, food, income and childcare — are part critical to addressing disparities seen in many conditions. Thus, the focus on connecting families to benefits like food assistance and housing support through clinics, community centers and neighborhood-based outreach.

“About 80% of health outcomes are driven by these factors, not what happens in a hospital,” he said.

So far, health officials are encouraged by data showing that participants have shown high rates of breastfeeding, about 47%, and high rates of on-time child immunization, with 91% of infants fully immunized by 24 months. Some have also been able to improve their education and employment prospects through the support, with 49% of clients who reported not working at intake having a job by the end of the program and 32% receiving a high school diploma or GED.

The programs have been available for nearly two decades and are based on national models proven to address disparities, Lednyak said. Recent investments have allowed the expansion efforts — under a broader initiative called Strong Foundations — that include broader eligibility and early childhood mental health support. For example, families who are already parents and in later stages of pregnancy can now enroll. 

Community-based organizations, including grassroots groups serving immigrant populations, play a key role in connecting families to the program through referrals, she said. Pediatricians, obstetricians and other healthcare professionals can also guide patients to enroll.

“Pregnancy, a child’s birth and becoming a new parent — while they can be a source of stress and anxiety — nobody should feel like they need to tackle this alone,” Lednyak said. 

Community groups and information remain critical  

Lednyak emphasized that the programs offer no-cost services regardless of immigration status, age or gender identity. 

Still, barriers remain. Language access, immigration enforcement concerns and lack of awareness continue to limit participation in available programs, particularly among Haitian and other immigrant communities. 

Dr. Christina Pardo, founder of Haitian Women’s Birth Equity, which refers families to the maternal health initiatives, said “hats off” to the city health workers reaching out to families. She sees them active at community events, community baby showers and other opportunities to connect with families who can benefit and raise awareness.

Some cultural barriers must be overcome, Pardo explained. One common obstacle is that people simply feel too much discomfort in their home setting or structure to have a stranger visit. However, having that support in place is a huge feat that will take people time to understand and use. Only then might the statistics regarding Haitians show a notable change.

“I expect that within a few years, we’ll start to see a shift,” she said. “I’m concerned the progress will be a bit dampened due to [immigration policy]. However, we’re fortunate that there’s a commitment and decision through DOHHM to continue to provide access to care and assistance as you normally would. The folks behind the scenes are working hard to deliver that.”

Marie, a client of Dr. Pardo’s organization, likewise feels there are so many services for fellow Haitians, that everyone should be informed and then make a decision. 

“I’m always telling people to get a doula,” Marie said, about a year after first learning they existed. “Everything my doula did for me, especially on the day of the delivery, charmed my heart. She did me a great service. That’s why we have to be open.”

To check if you are eligible for a maternal health program, call 311 or 718-637-5235, or visit nyc.gov/site/doh/ and search for Nurse-Family Partnership.

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