Aza Nedhari

Aza is transforming maternal health outcomes for Black women by building a representative perinatal workforce, integrating clinical care with home visiting and social supports, and demonstrating a replicable model that healthcare systems can adopt.

The United States is the most dangerous place to give birth among wealthy countries. Black women die from pregnancy-related complications at two to five times the rate of white, Hispanic, and Asian women. Decades of investment have failed to move these numbers.

Aza Nedhari's solution lies not in more technology or hospital protocols, but in centering the people most failed by the system and rebuilding care around their knowledge, dignity, and lived experience. The problem is not lack of access— among many issues, policymakers choose to negotiate reproductive rights and fail to promote reproductive justice, and families cannot navigate the structural barriers that put them at risk.

So, Aza created a new category of provider: the Perinatal Community Health Worker. The role combines the relational continuity of a doula, the practical problem-solving of a community health worker, the systemic literacy of a public health practitioner, and the cultural grounding of someone rooted in community. Graduates navigate housing systems, advocate in medical institutions, provide perinatal mental health support, and stand with women and families as they make decisions about their own bodies, their pregnancy, and their parenting journey.

The non-profit she co-founded, Mamatoto Village, operates on both sides of the care relationship. Its home visiting program provides continuous support from pregnancy through the postpartum period—care delivered by providers who share the lived experience of the women they serve. Its training program prepares Black women to become perinatal community health workers, and to become trainers, supervisors, and leaders themselves. For women from communities where careers in health care have been scarce, the training opens a path to economic security: sustainable work, professional standing, a role in transforming the system that failed them. This dual strategy attacks the crisis at its root: high-quality care for Black mothers today, a transformed workforce tomorrow, economic opportunity for the communities most affected.

The model is peer-led and self-reinforcing. "The women we serve are the women who serve." Many graduates join Mamatoto Village's care teams and rise into leadership—deepening the pipeline, ensuring lived experience stays embedded. Others disperse into hospitals, public health agencies, independent practices, and clinical careers. The first pathway sustains the model. The second spreads it. Scale does not depend on growing one organization. The spread is through people, not franchise.

By securing Medicaid reimbursement and shaping policy at local and national levels, Aza has proved that community-rooted care is not a boutique alternative but a replicable standard—one that operates outside the conventional health system while bridging patient and provider. The model changes who provides care, how it is financed, and who holds authority in maternal health.

The results speak: in a city where Black women account for half of births and 90 percent of pregnancy-related deaths, Mamatoto has served more than 4,000 mothers with zero maternal mortality. When women are believed, when providers understand both medicine and the material conditions of families' lives, avoidable deaths are prevented.

Demand for replication is growing. Aza is pursuing federal recognition of the home visiting model—a designation that would enable governments at every level to invest in adoption. At home, Mamatoto is expanding with plans to build a Certified Professional Midwifery program housed alongside the first birth center east of the Anacostia River.

Beyond that, Aza is modeling a design principle: co-design and build with those at the margins first. Centering communities most in need is not a niche equity strategy. It is a blueprint for a just and healthier system for everyone.

Maternal health is foundational—outcomes during pregnancy and the first year of life shape a child's health trajectory for decades. Yet the U.S. system treats it as peripheral. Postpartum care is often a single visit six weeks after birth, with no follow-up. The message is clear: once the baby arrives, the mother's health ceases to matter.

As a result, mothers in America are more likely to die during or shortly after childbirth than in any other developed country, and Black and Indigenous women die from pregnancy-related complications at nearly three times the rate of white women. In Washington, D.C., Black women account for just over half of births but 90 percent of maternal deaths. Seventy percent of those deaths occur in Wards 7 and 8—historically Black neighborhoods that have become care deserts. These statistics represent a public health crisis that has persisted for decades despite billions spent on maternal health interventions.

The problem, as Aza Nedhari frames it, is not that Black women need better access to care. The system itself—its institutions, workforce, payment structures, and clinical culture—was never designed to serve them. "We need to stop focusing on 'this is happening because you are a Black woman,'" Nedhari explains. "It's not because you're Black. It's the systems that Black women are having to navigate while they are pregnant." The focus must shift from race to racism.

The failures operate at multiple scales. At the interpersonal level, providers do not believe Black women's reports of pain or investigate warning signs with appropriate urgency. A 2019 study found that Black women were significantly more likely than white women to report mistreatment during maternity care—being shouted at, scolded, ignored. At the institutional level, Black women are more likely to deliver at hospitals with worse outcomes for all patients, but even within the same hospitals, they receive worse care. At the structural level, hospital closures have hollowed out access in Black neighborhoods. Ward 7 and Ward 8 lost their only hospitals in 2017; women must now cross the Anacostia River to deliver in facilities serving communities with dramatically different demographics and resources.

These patterns persist regardless of socioeconomic status. College-educated Black women have higher maternal mortality rates than white women who did not complete high school. The protection class typically provides does not extend to Black mothers. Structural inequities compound across a lifetime: chronic exposure to discrimination elevates stress hormones linked to preterm birth; limited access to healthy food, safe housing, and reliable transportation affects pregnancy before a woman ever sees a provider. Yet care systems are not designed to see or act on these factors. Health and social services do not communicate; providers lack both the training and the tools to address what lies beyond the clinical encounter.

The workforce meant to support maternal health does not reflect the communities at risk. Despite the historical prominence of Black midwives well into the twentieth century, barriers to entry have produced a perinatal workforce that is overwhelmingly white. Black midwives represent fewer than five percent of the profession; Black doulas, nine percent. Payment structures have compounded the problem. Research shows doula support reduces cesarean rates and improves outcomes, but most states did not reimburse these services until recently. Where reimbursement exists, rates often fall below the cost of providing care, making it difficult for community-based practitioners to sustain their work.

Billions have been invested in maternal health interventions, yet outcomes have barely moved. The reason: most interventions focus on the individual. Teaching Black women to recognize preeclampsia symptoms does not matter if their provider dismisses those symptoms. Providing transportation to appointments does not solve for shuttered hospitals. Nutrition education is irrelevant if a mother cannot afford groceries. These approaches misunderstand the nature of the problem. They ask women to adapt to a system that fails them rather than transforming the system itself.

What is needed is fundamentally different: culturally congruent care from providers who share lived experience, who believe what women say about their own bodies, and who support whatever decisions they make. Care that addresses social needs as inseparable from clinical ones. A workforce that reflects the communities it serves, with financing structures that make such work sustainable. None of these conditions reliably exist in conventional settings.

The moment is urgent: research shows 80 percent of pregnancy-related deaths are preventable, and states have begun expanding Medicaid coverage for doulas and while failing to advance investments in midwifery at the same pace. The infrastructure for a different kind of system is emerging.

Mamatoto Village is built on culturally congruent care: women receive services from providers who share their lived experience, who believe what they say about their own bodies, and who support their decisions. The name draws from "watoto," Swahili for child—motherchild held within a village, concentric circles of support. The model makes this structure literal: mothers become providers, providers train new cohorts, and each woman who passes through strengthens what exists for the next.

Two interlocking programs make this work. The Mothers Rising Home Visiting Program provides direct services to pregnant and postpartum women. The Perinatal Community Health Worker Training builds the workforce to deliver that care—recruiting heavily from program participants, so the two form a cycle that reinforces itself with each cohort.

Mothers Rising serves Medicaid-eligible pregnant women in Washington, D.C. and Prince George's County, Maryland, providing support from enrollment through three months postpartum—an average of 30 weeks. The women who come to Mamatoto are extremely high risk: financially insecure, often lacking stable housing or reliable transportation, facing the accumulated weight of conditions that conventional care is not equipped to address. Where most federally funded home visiting programs extend over three to five years, Mothers Rising concentrates on the highest-risk window: pregnancy through early infancy.

Enrollment begins with an assessment that identifies housing, food access, mental health, and family support—the conditions research links to preterm birth. Women are treated as experts in their own lives.

Each participant works with a coordinator, mental health specialist, and health and wellness expert—all trained through Mamatoto's pipeline, all drawn from the same communities they serve. They share the lived experience of the families in their care. They attend medical appointments to ensure concerns are heard. They advocate with landlords, navigate bureaucracies, and translate institutional processes that might otherwise overwhelm a woman managing pregnancy alongside poverty. During labor, community birth workers provide continuous support through hospital shift changes, ensuring women have a consistent advocate when they are most vulnerable. Home visits meet families in their own space, on their own terms.

The program offers information and then supports whatever path women choose. Hospital or home birth, epidural or unmedicated, breastfeeding or formula—staff provide guidance without judgment. This stands in contrast to conventional settings where Black women routinely report being lectured, dismissed, or having their choices questioned.

Services follow a cadence around critical decision points: breastfeeding guidance, postpartum planning, 24-hour follow-up after birth. Clients receive material support as needed and build relationships with other Mamatoto mothers through group sessions.

The results: more than 4,000 mothers served with zero maternal deaths, preterm birth rates well below regional averages, and a rigorous 2024 Georgetown study confirming significantly higher gestational ages among participants compared to matched controls.

Mamatoto contracts with four Medicaid managed care organizations in the D.C. area for reimbursement of services—a pathway that took years of advocacy to establish. Most comparable programs remain grant-dependent or struggle to secure reliable MCO payment for nonclinical work. Sustainable financing makes scale possible.

The second core program is training. "The women we serve are the women who serve," Aza says—and Mamatoto has built the infrastructure to make that possible. Standard doula certification requires fewer than 30 hours and does not address social determinants of health. Mamatoto's Perinatal Community Health Worker Training is far more rigorous: 240 classroom hours over six months, plus 10–15 hours of weekly independent study, followed by 18 months in the field and 1,500 hours of supervised practice. The curriculum covers anatomy and physiology, community health practice, counseling, mental health, reproductive justice, and lactation. Graduates choose among four career paths—perinatal community health worker, perinatal family support worker, community birth worker, or lactation specialist—and emerge able to navigate housing systems, connect families to services, provide mental health support, and advocate for patients within medical institutions.

The program recruits from the communities Mamatoto serves, including former Mothers Rising participants, and are seeing increasing demand from practicing OB-GYNs and midwives. Since inception, more than 250 women have been trained. Many join Mamatoto's care teams. Others move into public health, launch independent practices, or pursue clinical careers as midwives, nurses, and physicians. The variation is the point: rather than scaling a single organization, Aza is seeding the health care system with providers who carry community-rooted standards into their work. Each graduate who becomes a hospital nurse or a state health official brings Mamatoto's approach with them. And for women from communities where sustainable careers in health care have been scarce, the training opens a path to economic security—not charity, but professional standing.

The training now shapes practice beyond Mamatoto's own workforce. All 17 of D.C.'s home visiting programs are required to complete it, embedding these standards across the city's maternal health infrastructure.

Aza also works on policy. Since 2019, she has co-chaired the D.C. Maternal Mortality Review Committee—helping produce the evidence base that indicts the system while building the alternative. In 2024, she championed the D.C. Home Visiting Services Reimbursement Act, which extended Medicaid coverage for home visiting through DC HealthCare Alliance and the Immigrant Children's Program.

Mamatoto has pushed advocacy beyond clinical concerns. In 2024, with support from Merck for Mothers and in collaboration with researchers at Georgetown University, the organization published a housing justice framework examining how structural racism in housing policy affects pregnant women. Their advocacy led to the introduction of an amendment abolishing a D.C. law that bars women less than 28 weeks pregnant from family housing shelters.

Aza is building infrastructure for spread. In 2025, Mamatoto completed a capital campaign to purchase its Ward 7 building—a rare achievement for a Black-led organization in D.C. A second campaign is underway to construct a midwifery school and the first birth center east of the Anacostia. The nearest labor and delivery unit requires crossing the river into neighborhoods with different demographics and resources. A freestanding birth center would let women deliver in their own community, attended by providers who understand it.

Mothers Rising is in the final year of becoming a federally recognized home visiting model, a multi-year process that will unlock local investment in replication using federal funds and launch Mamatoto toward national scale. Meanwhile, Aza's team is developing an implementation toolkit for other communities, including tribal nations facing similar disparities.

Current health data systems cannot capture the mixed social and clinical data that Mamatoto tracks. Staff can access limited static data about a patient’s housing or mental health history but cannot inform these platforms. For the past few years, Aza has been building a custom electronic health record management system to serve their own needs, and ultimately solve for a huge barrier facing home visiting programs across the country. Launched in late 2025, it will be integrated into the Mothers Rising model. Mamatoto's participation in the Transforming Maternal Health Model—a ten-year, multi-state initiative to reform Medicaid care delivery—provides a vehicle for testing the technology at scale.

Women arrive at Mamatoto having been dismissed, doubted, talked over. They leave having been heard, believed, supported in decisions about their own bodies and their children's lives. Pa The outcomes matter: zero maternal deaths, reduced preterm birth, higher breastfeeding rates. But what Aza has built is also a village—group sessions where mothers form relationships, support groups for fathers, drives that provide material resources, a community that holds families after the formal program ends.

Aza Nedhari was raised by her grandparents in Alexandria, Virginia. Her grandfather was a minister whose church and living room were constant hubs of activity—cousins underfoot, aunts as co-parents, someone always on the porch or staying in the spare room. Care was collective, not a service delivered by professionals. Aza became "the helper": befriending quiet kids at school, listening as adults confided in her like she was their elder.

Her grandfather's library—Black history, political thought, science, theology—gave her a framework for understanding racism as structural, not incidental. He was the first person she knew who had gone to college, and she intended to follow. Both grandparents died before she turned sixteen. She graduated anyway and enrolled at Temple University.

During her junior year, community organizing pulled her in a different direction. She switched to African American studies and threw herself into local changemaking around food security and housing. Around the same time, a close friend went into labor while they were coordinating a racial justice march in Washington. By nightfall Aza was at the hospital, part of a small circle bearing witness to a birth.

Soon after, she became pregnant with her first child. She chose midwifery care and had a positive birth experience, but postpartum she found herself isolated, lacking the village she had grown up inside. As a new mother training to become a family therapist, she began to see what was missing for so many women during this time.

She became a Certified Professional Midwife and licensed family therapist, and across every role she kept seeing the same pattern: Black women facing preventable risks in systems not designed for them, supported by a workforce that did not reflect their experience.

After returning to D.C., Aza launched a pilot program for low-income pregnant women. She put out a call for twelve participants; more than forty women responded. They ran it without funding and were quickly overwhelmed. The women needed far more than doula support—they faced domestic violence, food insecurity, homelessness. After the first cohort, Aza ended the program. She needed to go back to the drawing board.

She reflected on her own doula training—too short, no social lens, inadequate for the complexity these women faced. She began developing a six-month curriculum tailored to community needs. She enrolled in midwifery school to deepen her clinical knowledge. In 2013, she co-founded Mamatoto Village with Cassietta Pringle, offering discounted doula services to Black and brown women and training others to join them. Their first grant was $4,000.

Two years later, an award led to a feature in Essence magazine. A Medicaid managed care organization reached out, asking how they could bring the program to their members. Aza asked to meet again in two months—and spent the interval developing what would become Mothers Rising. She understood that sustainable financing would determine whether the model could grow or remain small.

A decade later, Mamatoto is entering a new chapter with the model, the research, and the outcomes to support continental replication and uptake.