By Kiara Doyal, The Seattle Medium
A program designed to support Black women during pregnancy is helping shape ongoing efforts to address maternal health disparities in communities that have long faced unequal access to care.
For Black women, who face maternal mortality rates nearly three times higher than white women, access to basic tools like blood pressure monitoring can mean the difference between life and death. Programs like Heart, Soul, and Joy were created to change that reality by putting resources and support directly into the hands of those most at risk.
Launched during the COVID-19 pandemic, the University of Washington–affiliated program adapted perinatal care when in-person services became limited, providing participants with at-home monitoring kits that included blood pressure cuffs and wellness tools designed to track not only physical health, but also emotional and social well-being.
“The program was in response to COVID, but when COVID shut down all perinatal care for emergency visits, we had to shut down as well,” said Dr. Rachel R. Chapman, a professor of anthropology at the University of Washington. “But we knew that the community we served would absolutely have less access to blood pressure monitoring, which is lifesaving for Black women because hypertension or heart disease can impact pregnancy.”
The need for that kind of support was already urgent. In Washington state, Apple Care insurance did not cover blood pressure cuffs, creating a barrier for many families who could not afford the equipment on their own. During the pandemic, those gaps became even more visible, particularly in Black communities.
According to the Centers for Disease Control and Prevention, Black women in the United States experience maternal mortality rates of 50.3 deaths per 100,000 live births, nearly three times higher than white women. Many of those deaths are preventable and tied to long-standing gaps in care.
“A lot of people have a heightened risk of dying of eclampsia, or preeclampsia, during pregnancy, because they won’t have a blood pressure cuff. So, we wanted to get every single person that we could, and we started with the most at-risk communities,” said Chapman. “We call it heart and soul, because we know that people often die because of compromised health around heart wellness, and we wanted to give people the power to be their own monitor, and to say all of these things are for a good pregnancy and birth. And so that’s what we did.”
Beyond physical health, the program focused on a more holistic approach to maternal care. Participants used tools like the “Joy Quotient,” which encouraged them to track daily happiness and gratitude alongside traditional health indicators. The program also partnered with clinics like HealthPoint Obstetrics and worked with community-based doulas to strengthen communication between patients and providers.
Those partnerships, rooted in community knowledge and trust, have become a key part of improving outcomes for Black mothers and families.
Chapman said addressing maternal health disparities requires understanding the broader realities Black women face within the health care system.
“If you don’t separate how Black women die in pregnancy and birth-related causes, to other ways that we die, like heart disease and stress, nothing is going to change, and it hasn’t changed for years because the health system is not designed to treat all people,” said Chapman. “All the institutions that serve us have just come out of the colonial and racist roots of our nation to be infused with anti-blackness and especially violence towards Black women.”
“Even when we are the most resourced, educated Black women with the most privileges, we still die at three or more times the rate, because in those institutions, we are handled badly,” added Chapman.
Chapman said those disparities are driven not only by systemic racism, but also by gaps in how care is delivered and how patients are treated.
“Due to anti-Blackness, health care providers really thought that Black women don’t experience pain. If we are not taken or cared for seriously or empathized with as someone with feelings and that can feel pain, that is when we die,” said Chapman. “We are seeing that hesitancy to even tell the system that you are not feeling well, and a lot of folks dread going to the hospital as it is because they don’t think they are going to be treated well.”
Although the Heart, Soul, and Joy program is no longer active, its impact continues to shape ongoing work across Seattle and beyond.
“Work around Black maternal health is just continuing to build on the success of the Heart, Soul, and Joy program. Over a year ago, the American Heart Association Chapter of Washington reached out because they have never had a focus on Black women’s preeclampsia, and they wanted to join in on the work,” said Chapman. “That project has been going on for a year, ran in some of the clinics, and working with Rainier Valley midwives and some other organizations, working with doulas of color and providing access to blood pressure cuffs.”
Chapman said the work has continued to grow beyond the original program, including through a 2022 initiative led by the American Heart Association focused on improving maternal health through quality improvement and professional education, helping expand awareness and address disparities affecting Black women.
Those efforts have expanded into new collaborations, including a partnership between the University of Washington and Byrd Barr Place focused on improving outcomes for Black mothers and families.
“Our work has brought us into a new collaboration between the University of Washington and Byrd Barr Place. We are in the midst of something called the good Black birth initiative,” said Chapman. “And together, the anti-racist center for Health at UW and Byrd Barr Place have brought together about 15 Black birth working organizations to do what is needed to bring a good Black birth to all families and communities.”
Chapman said there are already signs that these community-driven approaches are making a difference.
“There is a Seattle hospital that started working with Black doulas and doulas of color, and they brought their cesarean rate down incredibly. All of the evidence is in the data, that what we are doing works best. That is why we have Medicaid paying for doulas, because we know that it improves outcomes for moms and babies,” said Chapman. “So, I have so much hope that people are finally listening to what is needed to help Black maternal health.”
Chapman said the growing collaboration between community organizations, health providers and advocates signals a shift toward more culturally responsive care, one that centers the needs, voices and lived experiences of Black women.
“I am so hopeful about the loving collaborations that are happening and the awareness that is being shown at the more public level. But I’m really glad that everyone is saying, let’s not lead with our own pathologization, let’s lead with our own beauty, ancestral wisdom, and joy,” Chapman concluded.
