How Community Workers Are Bridging Maternal Health Gaps
- Emma Davila
- May 28
- 5 min read
Authored by: Emma Davila
Art by: Kaitlyn Toung
According to the U.S Department of Health and Human Services, the United States has the highest maternal mortality rate among high-income countries [1]. In 2023, the maternal mortality ratio was 197 deaths per 100,000 live births globally, according to the World Health Organization [2]. It is clear that significant improvements are needed in maternal healthcare quality and access, and community health workers (CHW) may be a potential solution. CHWs are trusted, local community members who offer a uniquely personal and meaningful link between patients and access to high-quality and culturally-competent medical care [3]. In the context of maternal health care, CHWs offer a potential solution as they help bridge the gap between pregnant and postpartum women, especially disadvantaged, high-risk women, and their access to quality medical care, including prenatal care, trusted support, and comprehensible medical information. This support often appears through continuous emotional support and educational efforts that target pregnancy care, birth options, and postpartum recovery. In the United Kingdom, CHWs often take on the promotion of healthy behaviors in pregnant women and new mothers by encouraging quitting smoking, breastfeeding, safe sexual health, and physical activity [4]. On the other hand, a study with CHWs in rural Bangladesh showed that one strategy of successful CHWs in the promotion of better maternal nutrition and breastfeeding patterns was to adjust the delivery and narrative of their messages to appeal to the patient’s values and priorities such as health of the baby, reduced medical costs, and speedy recoveries [5]. This highlights how the success of CHWs in maternal care uniquely relies on the development of trusting relationships with patients and a true understanding of their community, as both maximize patient receptiveness to educational and behavioral change efforts, increasing their health outcomes.
Multiple studies have empirically shown the positive impact that CHWs have on maternal health markers. A study of mother-infant dyads found that participation in a program involving home visits from CHWs was significantly associated with a reduced risk of preterm birth, low birth weight, and an increase in adequate prenatal and postpartum care [6]. Furthermore, a study of Black pregnant women in Detroit found that participation in a program involving CHWs was associated with significantly lower rates of admission to the NICU and longer gestational length [7]. This study suggested the effectiveness of CHWs in mitigating racial disparities in maternal health as well as improving prenatal care and health outcomes among mothers and children experiencing a disproportionate risk of poverty, external stressors, inequities, and inadequate access to resources [7]. Furthermore, a study in Tennessee found that Hispanic mothers enrolled in a program MIHOW that involved the support of a CHW more frequently reported supportive and nurturing home environments for their child, including greater amounts of safe sleeping practices and reading aloud to their child. This result highlights how the benefits of CHWs in maternal health may stretch beyond improved birth outcomes and health for the mother, and have an additional positive impact on the rearing of the child and their health [8].
A systematic review found that the majority of studies reviewed involved CHWs who functioned as health educators as well as conducted home visits, suggesting these are two highly common responsibilities of successful CHWs [9]. An interesting adjustment to maximize the widespread usefulness and accessibility of home visits involves secure virtual meetings online that allow CHWs to meet pregnant women and new mothers with convenience, decreasing the likelihood of diminished benefits of collaborating with CHWs due to missed meetings.
Additionally, some studies have pointed towards the importance of integrating the use of CHWs within a larger program targeted towards improved maternal care. One study of CHWs in New York found that CHWs with higher levels of anxiety and lower job satisfaction had a higher risk of burnout and compassion fatigue. This highlights the need for team-based support with adequate communication channels and social recognition in programs with community health workers [10]. Without the support of a larger care team consisting of physicians, nurses, physician assistants, social workers, and more, the positive impacts of CHWs are limited, so modeling future programs with a similar structure to the WIN Network is essential, as demonstrated in one Detroit study [7]. This program’s success was largely due in part to its ability to link together larger healthcare institutions, social services, and clinical services, maximizing the various resources mothers and their infants have access to. This team-based approach includes measures to protect the mental well-being and capacities of CHWs, thus protecting maternal health outcomes by maintaining a consistent high quality of care for patients. The ability of community health workers to create positive impacts in maternal care is well documented in various clinical settings and with differing maternal populations. However, achieving the full benefits of CHWs in maternal health requires more beyond their mere presence – future integrations must include a larger care team and program, culturally competent training, and relational skills to ultimately maximize the positive impacts brought to the mothers they serve.
References
UNICEF. (2025, April). Maternal Mortality. UNICEF Data; UNICEF.
Gupta, A., & Khan, S. (2024). Importance of Community Health Workers for Maternal
Health Care Management. Public health reviews, 45, 1606803. https://doi.org/10.3389/phrs.2024.1606803
Grandner, G. W., Rasmussen, K. M., Dickin, K. L., Menon, P., Yeh, T., & Hoddinott,
J. (2022). Storytelling for persuasion: Insights from community health workers on how they engage family members to improve adoption of recommended maternal nutrition and breastfeeding behaviours in rural Bangladesh. Maternal & Child Nutrition, 18(4), e13408. https://doi.org/10.1111/mcn.13408
Meghea CI, Raffo JE, Yu X, et al. Community Health Worker Home Visiting, Birth
Outcomes, Maternal Care, and Disparities Among Birthing Individuals With Medicaid Insurance. JAMA Pediatr. 2023;177(9):939–946. doi:10.1001/jamapediatrics.2023.2310
Straughen JK, Clement J, Schultz L, Alexander G, Hill-Ashford Y, Wisdom K (2023)
Community health workers as change agents in improving equity in birth outcomes in Detroit. PLoS ONE 18(2): e0281450. https://doi.org/10.1371/journal.pone.0281450
Lutenbacher, M., Elkins, T., & Dietrich, M. S. (2023). Using Community Health Workers
to Improve Health Outcomes in a Sample of Hispanic Women and Their Infants: Findings from a Randomized Controlled Trial. Hispanic Health Care International, 21(3), 129–141. https://doi.org/10.1177/15404153221107680
Scharff, D., Enard, K. R., Tao, D., Strand, G., Yakubu, R., & Cope, V. (2022).
Community Health Worker Impact on Knowledge, Antenatal Care, And Birth Outcomes: A Systematic Review. Maternal and child health journal, 26(1), 79–101. https://doi.org/10.1007/s10995-021-03299-w
Rahman, R., Ross, A. M., Huang, D., Kirkbride, G., Chesna, S., & Rosenblatt, C. (2023).
Predictors of burnout, compassion fatigue, and compassion satisfaction experienced by community health workers offering maternal and infant services in New York State. Journal of Community Psychology, 51(4), 1820–1838. https://doi.org/10.1002/jcop.22967
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