Black women in America die from pregnancy-related causes at three times the rate of white women — with disparities that cross income, education, and access to care. Aza Nedhari co-founded Mamatoto Village to prove that a different outcome was possible. Since 2015, the organization has supported over 4,000 families in Washington, DC, with a zero percent maternal mortality rate. Here, she explains what community-based care actually looks like and why getting it right for Black women means getting it right for everyone.
Ashoka: Aza, let’s start at the beginning — what drew you to this work?
Nedhari: It wasn’t about spotting a gap in care. It was personal. My own upbringing had been very communal, and when I became a parent for the first time, I realized that I didn’t have that village around me. I really felt the loss. That became the seed for Mamatoto Village. I later connected with Kathryn Hall-Trujillo, who founded Birthing Project USA, and through her training, I met my co-founder, Cassietta Pringle. We spent a year alongside several volunteers, supporting teen moms in Washington, DC. We witnessed so much resilience, but also housing needs, safety needs, and food insecurity — things we did not have the financial capacity or infrastructure to address. That’s when Cassietta and I started building what would become Mamatoto in 2013.
Ashoka: You’ve maintained a zero percent maternal mortality rate among the families you serve — what’s the model behind this?
Nedhari: Our community-based home visiting program, Mothers Rising, has been running since 2015. We’ve supported over 4,000 families and maintained a zero percent maternal mortality rate. Its success is rooted in relationship-based, culturally grounded care delivered by a highly skilled and dedicated team committed to meeting families where they are. The program wraps around families fully through home visiting, education, perinatal mental health, nutrition, social needs navigation, lactation support, and high-risk care management. We work to resource the entire family through what we call a Three Generations Approach, a framework that looks at the intergenerational transmission of health, well-being, and social stability. We’ve also designed a community-created perinatal care management system to support program delivery that integrates clinical care and social needs into a single platform.
Ashoka: How are you expanding the workforce, and what does the training involve?
Nedhari: Each of our pathway tracks helps grow the health care workforce which is experiencing significant shortages nationally. Our model trains people from the communities we serve, credentialing them as perinatal community health workers, community doulas, or lactation consultants. We’re also creating a midwifery track for those wanting to become certified professional midwives. Training involves a rigorous didactic portion, competency based assessments, a certification exam, and practicum (field) hours. We have also pursued accreditation of our training from nationally recognized institutions.
Ashoka: Zooming out — what are some of the most common misconceptions about the problem?
Nedhari: First, that it’s a poverty problem. Income alone doesn’t explain the disparity. Black women with college degrees and middle-to-upper incomes are dying at higher rates than white women with less education and less income. Second, that better access to care will fix the problem. Research consistently shows that Black women’s pain is underrated, their concerns dismissed, and their symptoms attributed to non-clinical causes. You can have good insurance, a great provider, go to the best hospital, and still have a poor outcome. Third, it’s about lifestyle or personal choices. Arline Geronimus introduced the framework of “weathering” — the cumulative psychological and cellular toll of navigating racism over a lifetime and how it accelerates biological aging and affects cardiovascular function, immune health, and mental health. That is a structural injury, not a behavioral one. And finally, that it’s only about maternal mortality. Mortality is a visible metric: you lived, or you died. But severe maternal morbidity, the near-misses involving hemorrhage, infection, organ failure, ICU admissions, PTSD, impacts Black women at much higher rates, and in many jurisdictions, including Washington, DC, morbidity is not tracked. We’re missing the chance to make corrections at that level.
Ashoka: How do those misconceptions play out in practice?
Nedhari: They shape policy, funding priorities, and provider behavior. When you cluster all of these misperceptions together, it affects how people access care, experience care, and how care is funded. All of that gets codified. And that’s what makes getting the framing right so important. If you get it right for Black women, you get it right for everybody.
Ashoka: Looking ahead, what changes do you hope to see by 2030?
Nedhari: By 2030, I hope that we have a fully functioning birth and wellness center and midwifery school. This will be the first birth center east of the Potomac River, in Ward 7 [in Washington, DC]. This is a $10-$15 million project, and we will need partnership and investment to make this happen and ensure its sustainability. At the individual level, I hope that people are experiencing pregnancy, birth, postpartum, and parenting in a way that is safe, supported, and respected. At the systems level, I hope the outcomes of community-based models like Mamatoto are well-resourced and welcomed collaborators in the health and social ecosystem. And I hope Black maternal health stops being treated as a niche issue. Over 80% of maternal deaths in the US are preventable. This is a solvable problem. But it requires everyone to make maternal health their business.
Dr. Aza Nedhari is an Ashoka Fellow. This interview was edited for length and clarity by Ashoka.
