Mahabuba Masud, Michael Drake Philanthropy Fellow, The Commonwealth Fund
Although the United States is a high-income nation, it experiences a significant burden of maternal mortality incidence relative to other countries. In 2023, non-expansion Medicaid states had 27.7 percent higher pregnancy-related deaths than expansion states. The COVID-19 pandemic also exacerbated racial disparities in pregnancy-related deaths. Historically, marginalized populations, including low-income populations and Black and Indigenous communities are more vulnerable to preventable pregnancy-related deaths. In a 2020 study, it was found that Black and Hispanic women reported the highest rates of mistreatment, such as being shouted at, scolded, and ignored for help during their pregnancy. Other studies have shown that Black women receive lower quality obstetrical care, including the undertreatment of pain, delayed or inaccurate diagnoses, and mistreatment by their health care providers.
These disparate maternal health outcomes reflect the need for investments in community-based models that provide patients with quality care. Research shows a wide range of
community-based approaches could improve maternal health outcomes and patient experiences while also potentially reducing costs. Community-based models can include birthing centers, home births, and postpartum care with the support of midwives and doulas. These
community-driven models are well-positioned to advance maternal health because they bring together various sectors such as nonprofits, clinics, and foundations, integrate community voices, and apply strategies to drive lasting change. These models are vital to prevent maternal mortality, particularly for historically marginalized populations who are disproportionately impacted by the crisis. Philanthropic support of community-based models can help community organizations to develop and sustain maternal care outcomes.
Community birth settings have many benefits for birthing people and newborns. Compared to hospital settings, birthing centers have lower rates of interventions such as continuous electronic fetal monitoring and cesarean sections, more positive patient experiences, better outcomes for important indicators such as rates of preterm birth, cesarean birth, breastfeeding, and lower overall costs. Since community-based organizations (CBOs) work towards establishing trust and
leveraging partners for patient-centered and holistic care, they are uniquely equipped to address the diverse needs of birthing people. A recent study found that if a midwife workforce is integrated into health care delivery systems, it could provide 80 percent of essential maternal care around the world and prevent 41 percent of maternal deaths, 39 percent of neonatal deaths, and 26 percent of stillbirths. The various nurse-midwifery services located in underserved, poorly resourced communities in California, Georgia, Kentucky, and New York prove this through their safe neonatal and maternal outcomes.
There is a need to invest in community-based models to address the maternal health crisis, and there are opportunities for health philanthropy engagement in this landscape. Health philanthropies are uniquely positioned to fund innovative community-led initiatives to address systemic issues and support historically marginalized populations. With the rise in financial strains for community-based organizations, philanthropic organizations can engage in higher-risk and higher-payoff projects to drive systems change.
There are opportunities for health philanthropies to address the maternal health crisis in a variety of ways: strategic research grants, operations grantmaking, low-interest loans, convening opportunities, and more. Through this work, they can leverage their financial and social capital to be agents of change and ensure health equity initiatives benefit underserved populations.
One example of health philanthropy playing a key role in addressing the maternal health crisis is the Commonwealth Fund’s Financing Birth Equity Summit, which brought
multi-stakeholder coalitions to catalyze policy solutions. In January 2025, the Commonwealth Fund hosted this summit that brought together a diverse group of philanthropic funders, private capital and impact investors, and community leaders to strategize financing solutions for community birthing initiatives. The convening allowed space for organizations to engage in strategic planning, financial strategies, and capacity-building conversations. It demonstrates how philanthropic organizations can leverage their social and financial capital to bring multiple community organizations together, offer space for strategizing solutions, and address the maternal health crisis.
Philanthropic organizations can also drive equitable outcomes in maternal health through direct operational services. For example, the Mother Cabrini Health Foundation, a New York-based foundation, partnered with the Guthrie Clinic in March 2025 for the Maternity Oasis Mobile (MOM) Unit. Mother Cabrini Health Foundation provided grants for the mobile unit to reach rural residents in the Southern Tier and Central New York for gynecological and maternal care. The MOM units provide gynecological and maternal care such as prenatal and postpartum services, pregnancy confirmation, diabetic counseling, lactation support, and educational materials and resources for infant care. This initiative highlights how philanthropic support can expand access to quality care for low-income populations with limited transportation access.
Health philanthropies have an opportunity to engage with community-based models in innovative ways to improve maternal health outcomes. They can collaborate with organizations to address gaps in public systems through strategic grantmaking, operational support, and convening opportunities. This can look like research grants to understand disparities within the maternal health crisis, supporting birth centers through operational costs, and convening opportunities to explore the benefits of midwifery and doula-led care, and more. Health philanthropies can play a significant role by leveraging their resources to sustain community-based models and drive equitable maternal health outcomes.
Supported by the Commonwealth Fund, a national, private foundation based in New York City that supports independent research on health care issues and makes grants to improve health care practice and policy. The views presented here are those of the author and not necessarily those of the Commonwealth Fund, its directors, officers, or staff.