Building sustainable, impactful perinatal community health worker programs

One potential solution to tackle widespread disparities in maternal health has been increased access to doulas—people who provide emotional, informational, and physical support around and during the time of birth.

However, people need support navigating challenges throughout the entire perinatal course, which can be almost two years including prenatal and postpartum periods. Additional support is critical for people who face barriers to the best pregnancy outcomes because of socioeconomic status or systemic racism.

More people recognize the need for professionals such as perinatal community health workers (CHWs), support workers with specific expertise in pregnancy, birth, and postpartum care. With shared lived experience or closeness to the communities they serve, CHWs act as trusted liaisons among clinical, social services, and the community and are well-positioned to provide psychosocial screenings, address social needs, and connect people to resources.

In a new paper in Health Affairs, Malini Nijagal and colleagues share lessons learned for policymakers to design or restructure perinatal community health worker programs.

  • Reimburse for perinatal CHWs at a high enough rate to sustain work, including non-patient-facing tasks. Reimbursement must be significant enough to provide a living wage and make it feasible for clinics, community organizations, or others to employ them.
  • Allow payment flexibility so perinatal CHWs can be reimbursed for work in community and healthcare settings. Local context should guide whether perinatal CHWs are hired by healthcare organizations or community organizations.
  • Incentivize coordination and data sharing to prevent patient harm and system inefficiencies. Programs delivered in silos without incentives for coordination can put a burden on patients and create inefficient systems.
  • Standardize screening questions and collect data to track population health and health disparities. Infrastructure is key to tracking social needs data so resources and programs can be adapted over time.
  • Provide perinatal CHWs with adequate support and training to prevent burnout. It’s imperative to intentionally create meaningful, adequate space for perinatal CHWs to discuss challenges and receive support.

As more perinatal community health worker programs develop to better support comprehensive care for people before, during, and after pregnancy, program design is essential to facilitate positive, sustainable impact.