On a vibrant spring morning in Merrillville, Ind., almost 400 girls and their households kind a line exterior the Dean and Barbara White Middle, ready for the doorways to open. They’ve come for what was marketed as a well being truthful, however what they’ll expertise is extra akin to a neighborhood revival, one centered on remodeling maternal well being outcomes in considered one of America’s most difficult areas for Black moms and infants.
Inside, Dr. Maya Dominique strikes between stations with practiced effectivity, checking in with the 88 distributors who signify not simply well being care providers however a complete ecosystem of help: housing sources, job alternatives, instructional pathways, and sensible providers like free haircuts and hair braiding for moms who hardly ever have time for self-care. For Dr. Dominique, this evolution from conventional well being truthful to holistic wellness occasion represents the end result of years spent recognizing that medical care alone can not remedy America’s maternal well being disaster.
“I modified it from a well being truthful to a wellness truthful,” Dr. Dominique explains, “as a result of what I understood was that well being and wellness was not nearly whether or not they got here to the doctor, however did these girls have a secure place to remain? Have been these girls in abusive relationships? Did they know the place to go in the event that they didn’t have components or diapers for his or her child?”
The disaster past scientific partitions
The statistics that drive Dr. Dominique’s work are stark. In Lake County, Ind., the place she practices, toddler mortality charges attain 14 per 1,000, almost thrice the nationwide common of 5.6 per 1,000 stay births. These disparities replicate not simply medical challenges however systemic inequities that standard healthcare struggles to handle.
“My sufferers shouldn’t have the flexibility to go to grocery shops with a lot of fruit and veggies,” she notes of Gary, Ind., a documented meals desert. “A few of these issues are literally systematically arrange, which then put girls in these horrible positions.”
Dr. Dominique’s journey to addressing these challenges started with a childhood calling. “So long as I can bear in mind, I’ve all the time wished to ship infants,” she says. “As a 5-year-old, I didn’t have a doctor in my household that I used to be trying as much as, so I simply know that it was a calling from God.”
That calling led her via deliberate instructional decisions: changing into a licensed nursing assistant to grasp bedside care, finding out overseas to study completely different cultural approaches to well being, attending medical college at Rosalind Franklin College in Chicago, and finishing her residency at Mercy Hospital on town’s South Facet, the place her sufferers have been predominantly girls of coloration.
“I can depend on one hand, out of the entire a whole bunch of deliveries that I did at that hospital, I in all probability solely interacted with lower than 10 Caucasian white girls,” she remembers. It was throughout this residency that nationwide consideration started specializing in Black maternal mortality charges. “That’s when it was like, ‘Whoa! I’m in the suitable place on the proper time to take motion.’”
From doctor to motion builder
The normal profession path for a profitable obstetrician-gynecologist usually leads deeper into hospital methods or personal observe. Dr. Dominique selected a unique route. In 2023, she stepped away from full-time hospital employment to develop into an impartial contractor, creating house to pursue her imaginative and prescient via Prenatal Nicely, her nonprofit group devoted to lowering maternal and toddler mortality.
“I’m now an impartial doctor, I can create my schedule how I need to, and I can nonetheless go after my ardour,” she explains, acknowledging frequent considerations about work-life steadiness in medical careers. “Generally we expect like, ‘Oh, effectively, I need to do one thing that’s fast and quick,’ however for those who’re actually following your ardour, for those who’re actually doing what you actually need to do, that point will go so quick.”
This transition allowed her to increase her strategy past conventional medical interventions to handle what healthcare researchers more and more acknowledge as “social determinants of well being”, the situations by which individuals stay, work, and age that considerably impression well being outcomes.
The 4 foundations of neighborhood wellness
Dr. Dominique’s mannequin builds on 4 interconnected pillars that collectively create a basis for improved maternal well being:
Recognizing that meals deserts signify a basic barrier to maternal well being, Dr. Dominique has established partnerships with native Black farmers to carry contemporary produce on to the neighborhood. She additionally supplies cooking demonstrations that remodel acquainted cultural staples into more healthy variations.
“We did a full culturally delicate menu,” she explains of a current well being truthful. “We had baked rooster, we had collard greens, candy potato, we did a vegetarian chili. We confirmed them learn how to do a smoothie, and none of this was made with any sugar and salt.”
The impression was quick: “The children have been arising, all people was arising for seconds and thirds, after which we instructed them it was no salt, and nobody might consider it.” Attendees left with recipes and a brand new understanding that wholesome consuming might align with cultural meals traditions.
Dr. Dominique has developed instructional sources together with a information that includes the “prime 10 questions” girls ought to ask their physicians throughout being pregnant. These questions embrace seemingly easy however probably life-saving inquiries comparable to, “Have you learnt the hospital the place you’re delivering at?”
“Generally we don’t understand that our hospitals are tiered regarding the sources that they’ve, and it goes from stage one to stage 4,” she explains. “In case you go to a stage one hospital and also you’re having a placental abruption, there’s no doctor that’s on the hospital. There’s no anesthesiologist on the hospital, that may very well be life or loss of life between you and your child.”
The growth of Dr. Dominique’s annual wellness truthful displays her understanding that maternal well being relies on stability throughout a number of domains. The occasion now consists of sources for secure housing, home violence intervention, child provides, schooling, and employment alternatives.
This 12 months’s truthful even consists of army recruiters, an acknowledgment that sustainable financial pathways signify a key element of household well being. “You by no means know who would possibly need to go into the providers as a result of we additionally want employees within the providers,” she notes.
Maybe most innovatively, Dr. Dominique has included males into her maternal well being technique. “We have now a males’s survey that we’re doing to be sure that we all know how they really feel when their companions are pregnant, after they’re changing into fathers, what they should be sure that they’re geared up with the information to handle their households.”
This strategy acknowledges that supportive companions can considerably enhance being pregnant outcomes, but males are sometimes excluded from maternal well being initiatives.
A mannequin for nationwide replication
Whereas Dr. Dominique’s work is centered in Lake County, Indiana, her strategy presents a possible template for addressing maternal well being disparities nationwide. By recognizing that healthcare occurs primarily exterior scientific settings and constructing infrastructure that addresses the complete spectrum of wellness wants, she has created a community-based mannequin that may very well be tailored to different areas going through related challenges.
As Black Maternal Well being Week brings nationwide consideration to those disparities, Dr. Dominique finds solidarity in a rising motion. “I’m not alone on this combat. There are girls all throughout the nation this week which might be making an enormous distinction with regard to Black Maternal Well being Week,” she says.
For the ladies of Lake County, Dr. Dominique’s efforts signify greater than healthcare, they provide hope. In a area the place statistics paint a grim image, her work demonstrates that community-driven interventions can create pathways to higher outcomes. By means of Prenatal Nicely, accessible by way of Instagram and Fb, she continues to increase her attain, providing sources, steerage, and a imaginative and prescient for maternal healthcare that facilities Black girls’s wants and experiences.
In Dr. Dominique’s strategy, we glimpse a future the place maternal well being disparities are addressed not simply via medical interventions however via complete neighborhood transformation, a imaginative and prescient that extends effectively past hospital partitions.