This interview with Hakima Payne, Founder and Executive Director of Uzazi Village, by Rebekka Dekker, Founder of Evidence Based Birth®, was originally published by Evidence Based Birth® Podcast on August 9, 2023. ((Republished with permission from Rebecca Dekker, Evidence Based Birth Podcast (August 9, 2023), https://evidencebasedbirth.com/ebb-278-creating-an-innovative-afrocentric-model-of-prenatal-care-with-hakima-payne-founder-and-executive-director-of-uzazi-village/.))
Transcript
This transcript has been edited for clarity.
Rebecca Dekker: Hi, everyone. On today’s podcast, I’m so excited to welcome Hakima Payne, Founder and Executive Director of Uzazi Village. We’re going to talk about her creation of the Village Circle ApproachTM, an innovative Afrocentric model of prenatal and postpartum care, and her work to eliminate maternal health disparities in African American communities.
Ms. Payne, known as Mama Hakima by many in her community, is the creator of the Village Doula Program, which is a community-based home visiting community health worker program for pregnant families. She also created Chocolate Milk Café, a breastfeeding support group for Black families, the Village Circle, which is an Afrocentric group prenatal care model, and a curriculum called Culturally Congruent Care, which is an anti-racist medical education curriculum.
Hakima also sits on her local Fetal Infant Mortality Review Board to address Black infant mortality and has been appointed by her city’s mayor to serve as a health commissioner. Mama Hakima is a certified trainer for community health workers and she speaks nationally on the topics of Black maternal and infant health. Ms. Payne works relentlessly to make birth safer and the village healthier, and to promote anti-racist models of care for African American families.
She is the subject of a documentary that just came out called Sister Doula, and she’s going to be featured in a second upcoming documentary called Pregnancy and Prejudice. Ms. Payne resides in Kansas City, Missouri.
We are so thrilled that you’re here. Welcome, Hakima, to the Evidence Based Birth® Podcast.
Hakima Payne: Thank you. I’m delighted to be here.
RD: You have such an impressive bio, and you’ve made an impact in your community, and you have been doing so for a long time, since before the first time I met you, which was maybe nine or ten years ago at a conference. Can you talk about what first brought you to birth work and why you and the three other founders made the decision to start Uzazi Village?
HP: Sure. I was brought to birth work by my own births. Of course, I started out as a birthing person myself and loved birth, was very passionate about birthing and breastfeeding my own babies, which led to my desire to do birth work. I started out as a doula, went to nursing school, became a labor and delivery nurse, later became a nurse educator, teaching nursing students labor and delivery, and then later started Uzazi Village.
That was 2012.
I actually invited the other three co-founders into this vision. The vision was something that had come to me and I invited them to join me on manifesting the vision, which they did. And that was eleven years ago. We just celebrated our eleventh birthday here at Uzazi Village.
RD: It’s so incredible the impact you’ve made on your community. When you mentioned you’re inspired by your own babies and birth experiences, did you feel empowered by birth, or did you have traumatic experiences, or a mix of the two?
HP: I would say a mix of the two. The real turnaround came when I had my first home birth. I have nine children and it was with baby number four that I had my first home birth. All the rest after that were born at home. I’ve had a total of six home births. I would say yes, that really empowered me and really changed me. I was already passionate about birth, but when I found how birth could be in a home setting or a birth center setting, I was really excited to help birthing people embark on that kind of birth journey.
RD: Were these births in Kansas City?
HP: Yes, yes. Born and bred Kansas Citians. I’ve only lived here. We have a really robust midwife community here. I was able to find what I needed for my six home births and that really inspired the rest of my work and the rest of my career.
RD: How has the birth environment changed in Kansas City over the years from when you first started having babies to more recently?
HP: I would say it essentially hasn’t changed much at all, and I think that’s part of our role here at Uzazi Village. I think more Black and brown women than ever are discovering that they have options in birth. They’re discovering what a doula is and how a doula can be beneficial. They’re learning how to advocate for themselves in healthcare settings, and they’re learning that birth centers and home births are options. I do see that slowly shifting and I’m proud that we’ve been a part of that shift.
RD: The hospital systems have stayed somewhat the same over the years?
HP: Yes, yes. I see them trying to reach out and understand the doula role a little bit more, and we’re actually helping them do that. We’re offering a series of lunch and learns at our local hospitals to help providers understand how the role of the doula is beneficial to their clients as well as to them. We’re seeing a slow shift.
RD: What I remember being struck by when I first heard you speak ten years ago was that you saw these gaps in the care, that people were not receiving safe, empowering care in hospitals, and so you decided to just build your own village essentially within Kansas City. Can you talk about the unique initiatives that Uzazi Village has brought to your community?
HP: We have evolved slowly over time because capacity is always an issue. We’re just one small nonprofit organization. But we set about right away to educate our community because there’s a lot of gatekeeping of knowledge. That’s been a core activity of ours from the beginning, to get the knowledge out there. We have monthly childbirth classes. They’re free. They’re open to the public, as are all our services, free and open to the public, combating some of that knowledge gatekeeping and access to services. We have our village doulas who are out serving community. And now, a year and a half into our prenatal clinic, the Ida Mae Center, we’re offering our community a new and different way to experience prenatal care.
We call this creating adjacent systems. All of our systems, all of our programs within our systems, I should say, are Afrocentric. They’re really focused on the health and well-being of Black families and secondarily brown families as well. We have our office in Kansas City, Kansas, which primarily serves Spanish-speaking folks.
That’s what we brought to our community: actual options and expanded knowledge.
RD: I remember that that was one of your big steps, establishing the doula program and training doulas.
HP: We’re still doing that work. We’re doing it like gangbusters now. We travel too. We had a contract with the State of New Jersey and trained about 200 doulas throughout the state. Right now we have a state contract with our own state here in Missouri. We’re training doulas all around Missouri. We have a contract to train about 150 doulas a year over three years and, again, that’s to expand and create the doula workforce in preparation for changes that are coming down the pike for doula reimbursement.
We’ve had a key role in policy and legislative efforts. We’ve spent a lot of time this year educating legislators and lobbyists on what a doula is so that they can pass legislation on doula reimbursement through Medicaid and private insurance. We’ve had our fingers in a lot of different work this year, especially the advocacy and policy work, as well as just providing community services and support.
RD: When it comes to the legislative process, I’ve talked a lot with our team here at EBB about some of the drawbacks of legislating doula reimbursement. Obviously we want doulas to be paid, but sometimes the legislation does not pay them fairly or it leads to models that are only accepting doulas with certain certifications. How have you dealt with that problem?
HP: Yes, it’s definitely been a two-edged sword, and we’re dealing with legislators or folks passing this legislation who don’t even know what a doula is or never even heard of a doula before this legislation appeared. We have tried to learn from all the legislative organizing that has happened in other states. We’ve really tried to learn from that and organize as doulas and as doula organizations.
We formed our own coalitions to speak not only to legislators and policymakers but to government agencies that oversee these decisions so that when they have questions about doulas they can call on the organization. They can call on the coalition and we can say, “Hey, here’s what you really need to know. Here’s what doulas really should be making. Here’s what’s reasonable. This is why. Here’s the justification for that level of pay or that level of compensation. Here’s what we’ve seen in other states. Here’s lessons learned.”
We’ve really been on an education campaign with government agencies, payers, MCOs, policymakers, legislators. It’s taken that to keep our state in check. We don’t have legislation yet, but it’s definitely coming and folks are ripe for it because it’s a trendy issue. Folks are easy. Legislation is actually easy. They’re eager to get their name on legislation around Black maternal health so they can say they did something even if they’re not really invested in the quality of that legislation. We’re there to provide the checks and balances and to say, “Wait a minute, you can’t do that. You need to do this.” Doula advocates, such as myself, doula policy wonks, and researchers like me have been front and center, talking to all the decision makers who don’t know what they’re doing but think they do.
RD: Education is a theme again.
HP: Yet again.
RD: Your legislation and policy work.
HP: Right. Lots and lots of meetings, lots and lots of trips to the State Capitol is what that means. We’re hoping to bypass some of the mistakes that have been made in other states.
RD: We just saw each other at the Anarcha Lucy Betsey Second Day of Reckoning in Alabama. You were one of the speakers on stage and you talked about the Ida Mae Center. Can you explain what the center is, where it got its name, and what you’re doing that’s so unique with this model?
HP: Sure. I love to talk about the Ida Mae Center. Ida Mae Patterson was my grandmother, so I named my clinic after her. It’s a family name. The model is a unique one that I created that I call the Village Circle. In the Ida Mae clinic, we utilize the Village Circle model, which is a group prenatal care model. It’s also an Afrocentric model, so it’s a model built for families of the African diaspora.
Our clinic is really unique even though it is a prenatal care clinic that gives standard prenatal care. The environment that we wrap our community members in is an environment that celebrates their uniqueness and amazingness as African people. We do that in a number of ways. We do a family photo shoot every year of our families and we hang those pictures on the wall. We also have an Afrocentric approach to care. Because it’s a Village Circle model and a group prenatal care model, our clients come in cohorts so that they can bond and build relationship with one another. We do multidisciplinary care with wraparound services. We try and provide not all but most of the care they need. Our clinic is midwifery driven, so we only have midwives, not physicians. Every client in our clinic is assigned a doula. We also have mental health services. We have nutrition services, lactation services. Our care is really built on the premise of education. We don’t have a waiting room in our clinic, we have an education room. Every minute they’re here is utilized with one of our clinicians or educators.
The structure and the client experience flow are very unique. There’s a huge emphasis on relationship building. It’s very casual and everyone interacts with everyone. There are no hierarchies. There are no barriers that separate providers from the recipients of care. We have an herbalist on board and a community garden, and both of those are used toward healing modalities. If the midwife finds that a client has a low hemoglobin and needs to boost her iron stores, she’ll be sent to the herbalist to get teas that contain iron boosters.
And that might be used in conjunction with pharmaceuticals or separate from pharmaceuticals. But we try to take a holistic approach. A lot of the clients want to move away from allopathic models of care into more holistic care modalities. We try to accommodate that. Our therapists are always present in the clinic so that, again, they’re creating a relationship or removing some of the stigma around mental health strategies.
It’s a unique experience that people tend to really love. Even our visit rubric is different. Folks come every two weeks throughout their pregnancy and we see them for twelve weeks after delivery.
RD: Wow. It’s just like, when you describe it, it’s so opposite from how most prenatal clinics are run, where you go to a waiting room, you wait for a really long time in a small room, and you wait for the doctor or the midwife, and that’s all you see for maybe five minutes and then you’re gone. When you gave your presentation, one of the things that really struck me aside from it being an Afrocentric model was that you had a chef on your staff at the clinic. Can you talk about Shafeeqa and her role?
HP: Shafeeqa is a phenom. I jokingly call her a food therapist because she’s always inviting our care participants—which is what we call them, we don’t use the term patients, they’re our care participants—she’s always inviting our care participants to examine their food relationships. While she’s in the kitchen preparing foods—and we have an open kitchen concept—going to the kitchen is actually one of the stops on our client visits.
RD: It’s part of the prenatal visit.
HP: It’s part of the prenatal visit. Go to the kitchen and see anybody over on this side, get some food and talk to Shafeeqa. While she’s feeding them, she’s also educating them and inviting them into conversation about their food relationships. A key component of the Village Circle model is the debrief that happens afterwards. As soon as a cohort, say the two morning cohorts leave, then we have a two-hour break—one hour is lunch, but the other hour is debrief—and then the two afternoon cohorts come. What we do during debrief is talk about every case and every provider. Because it’s an egalitarian model not a hierarchical model, everyone comes and sits around the table and we go through every care participant’s case. Surprisingly or not surprisingly, Shafeeqa often has the most interesting information to contribute. What we found over time is that clients will tell her things that they won’t tell anyone else because they just loosen up and open up and become more vulnerable over a plate of good food.
Shafeeqa is also a plant-based chef, so she’s introducing them to new ways of cooking and new ways to utilize the foods that they’ve eaten before. I would say that having a chef is really key.
The reason this developed, although it has evolved in a way that is way superior to what I ever imagined because Shafeeqa just brings an entirely new embodiment to it, is that I felt like we should have some sort of food preparation as a part of the experience because nutrition education is really important to me. But I wanted something far beyond just handing someone a sheet of paper and saying, “Here, these are the foods you should be eating.” I wanted them to have a food experience. Shafeeqa has been perfect for that because she’s so outgoing, she’s so personable, and she totally disarms people, opens them up, gets them talking. Often their conversation is about food, but she’ll get other pertinent pieces of information as well. When she comes to debriefing and shares, we all look at each other and say, “How’d you find out about that? They didn’t tell any of us that.”
So I believe that role has been really key. We’ve learned a lot from it. Of course, everything about our clinic experience is experimental. We’re trying things out.
I was recently approached by someone from the state health department who asked us about the possibility of adding dentistry to our offerings. I said, “Yes, I’m all for that.” The state is giving us money to set up a local dentist. We’ve entered into a partnership with a local dentist. The state will pay to outfit a dental office, not a full-fledged dental office, but the basics. All they’ll be doing here is exams and cleaning, so just very basic. But that will give the dentists an opportunity to screen for things like periodontal disease or other issues that might impact a pregnancy.
RD: Yeah, I don’t think most people realize that inflammation in the mouth can lead to systemic inflammation, which can affect pregnancy outcomes.
HP: Yeah, dental health issues can absolutely lead to preterm labor. We’re excited for that partnership and that the state initiated it. We didn’t ask them. They asked us. For me, things like that are really exciting. That people see our clinic as a promising model and that we’re introducing some interesting ideas that maybe people should think about. Prenatal care essentially hasn’t changed very much over the past century. I love that we’re on the cutting edge. As we think about how to make prenatal care better for Black women, we’re actually making prenatal care better for everyone. That does excite me. We’re a year and a half into our two-year pilot on the clinic, and then we’ll decide from there what’s next. Probably keep going. We have no plans to stop, but we probably will have to switch over the design of our clinic. But the essential services will stay the same.
RD: One more thing about Shafeeqa. People not only get a meal while they’re there, but she sends them home with food sometimes too.
HP: Yes. Shafeeqa is also in charge of preparing our postpartum meals. When our doulas do their postpartum visits, they grab a meal out of the freezer that Shafeeqa has prepared for them and they take a meal or two on their first postpartum visit to the client’s home. Shafeeqa has been known to create meals and meal plans for folks who have had losses or for folks who have had extended hospital stays or for folks who had babies in the NICU. We have provided meals on a case-by-case basis for special situations.
RD: How is this work funded?
HP: I would say by hook and by crook, but we are funded. We have relationships with several philanthropic organizations, so we get your basic grants that a lot of nonprofits get from philanthropic organizations. I think our grant funders have been pretty generous with us. We’re supported. We get some funding from our state and we get some funding from our city. We have contracts with MCOs. We’ve had contracts with other entities. Right now, we have a contract with one of our local hospitals heavily involved in research. They’re sending clients to us as part of a research project, measuring the outcomes of clients who have the hospital’s regular prenatal care versus clients who have the regular prenatal care plus one of our doulas, and then they’re going to measure the outcomes. So we get bits and pieces of funding from a lot of places, and of course, we’re supported by donors in our immediate community, as well as nationally, corporate donors, individual donors, and we just piece it together. And we do have products to sell. That product is our doula training, and we also train community health workers. We’re always maintaining training contracts to do those trainings. Bits and pieces from here and there, but it gets the job done.
RD: In addition to supporting families, I know that your work is known for being very supportive of trainees through creating clinical hours and internships and taking student midwives, and we know there’s a lot of burnout in these fields. Can you talk about how you’re helping create a more sustainable workforce?
HP: Yeah, there is a lot of burnout. Because we’re egalitarian and nonhierarchical, because we’re womanist-based, and because we’re Afrocentric and seeking to restore village models within organizations and within healthcare, we do things differently. Here in our organization, as a Black woman-led organization, we’re not attempting to emulate a capitalist model but, like I said, more womanist models with our board and mostly Black female staff that we have here.
To your other question, we do take a lot of students. We’re big believers in pipelining, so we’re always trying to build and maintain those pipelines of doulas, midwives, lactation consultants, and other healthcare providers in the perinatal field. We provide opportunities for internships, for student observations. We have our own tracking and training programs for doulas, of course, but just trying to create a gentler workforce where we have… Just as we have debriefing after our clinic, we have weekly team meetings where everyone sits around the circle and everyone has their input. Everyone has a say. Everyone’s contribution is given weight. It’s not top-down here. We all participate in the circle as contributors and everyone’s ideas are welcomed, valued, and considered. I would say there’s lots of ways that we invite folks to come and see how we move. We recognize that our ultimate authority comes from the community we serve and from the care participants that we help provide care for. We’re constantly taking their input and that means our community has greater expectations. They don’t look on us like they look on the hospitals, which they view as essentially not caring. They hold us to a higher standard because we are a part of them. We want to be held to a higher standard. We want healthcare overall to be held to a higher standard. It’s our job to model that first and that’s a charge we take very seriously.
RD: You mentioned that families get prenatal and postpartum care there. What about the birth care then? Do they have cohorts or hospital—
HP: Our families deliver primarily in hospital, but also in our local birth center and at home. The two midwives that work in our clinic also have a home birth practice, so they can sign up for home births if they meet the medical criteria for it. Our clients give birth in all settings, and we support that. Like I said, we want our clients to have the options that everyone else has. We’re trying to facilitate the creation of greater options and possibilities for our community.
RD: Say someone seeks prenatal care and is in a cohort at the Ida Mae Center and they’re planning a hospital birth. Do they also have to have care with an OB-GYN or nurse midwife?
HP: We do encourage our clients to establish care at their delivery hospital where they won’t have a full compliment of prenatal visits, but they should establish care there. We send their records over at thirty-six weeks. They may be planning to deliver at a specific facility but they do their prenatal care here.
RD: I was curious, is there any data that you have that you can share with us on either your doula program or your Ida Mae Center, or is that still in process?
HP: Well, that’s great that you asked. Yes, we are constantly in the process of collecting data and analyzing data. We did release a report last year of ten years of doula data. We released that report, and right now we’re working with one of our local universities to analyze our data on the first-year cohort. We’ve just engaged a husband-and-wife epidemiology team to do focus groups with that first-year cohort. They’re going to come and do some qualitative analysis to hear more about what their experience was like getting care at the clinic.
We’re hoping to use that data to refine our processes, to see where our weaknesses lie, and to understand if there are any gaps in care that we can fill. We’re constantly doing that. We’re excited to do that.
I can tell you a little bit more about the report we released last year. Since the first-year data is still in process, we don’t have those reports yet. They’re being done right now. But regarding last year’s report, we found that we did make significant improvements when we compared our clients, our mostly African American urban dwelling clients, to the local city health department data. We’re trying to compare like against like. A lot of the urban zip codes that the health department’s looking at are African American zip codes where African Americans primarily reside. We found that we were doing significantly better in helping pregnancies go to term, which is one of our primary objectives as an organization since the leading cause of death for African American babies in this country is complications related to prematurity. All of our programming, specifically the clinic and the doulas, aims to decrease prematurity by helping to keep folks pregnant until term. The data showed that we were doing that. It also showed that we had really good breastfeeding rates. We promote breastfeeding a lot. Patient services are embedded in our clinic and we do a lot of prenatal education around breastfeeding. And then we offer a lot of in-community support for breastfeeding. The data showed that it was successful. Birth weight was more modest. Our babies were in the average range, but on the lower side of it. But overall the data was really promising.
One of the things that surprised me is that we don’t see a lot of teen pregnancy in our center. Most of our folks are in their twenties and thirties. I would say overall the data showed some really promising results. We hope to dig deeper, looking at things like induction rates, cesarean rates, NICU stays that really lead the charge of perinatal complications for our community.
RD: I want to encourage everyone to go to uzazivillage.org and hover on the main menu over initiatives. There is a sub menu called research projects. If you click on that, you’ll see the research results that Hakima is talking about with more details and exact numbers. I encourage you all to check that out. There’s also a video presentation about their experiences that they’ve had there. Really helpful.
HP: I’m essentially a researcher myself, so tracking the numbers is really important because I’m not just creating these models for my immediate community. I want to track the effectiveness of these models and I’d like to see them scale and replicate, if possible. Collecting the data is a really big part of what we do.
RD: Hakima, not only does the data support your work, but so do the reports of people who work with you. You’re so highly respected in the field. I’m just really honored you came on the podcast today. Can you share any final words of how people can follow you or support the work of the Ida Mae Center and Uzazi Village?
HP: Thank you for that compliment, Rebecca. You’re certainly well-regarded around here. The doulas were over the moon when they heard I was going to be on your show. Our doulas use your website as a resource a lot. It comes highly recommended. Of course, you yourself are highly respected in the perinatal community, so right back at you. I would say I’m a Facebook person. I’m on Instagram as @hakima_the_dreama, so you can definitely find me there. I’m always out there pontificating and giving my two cents worth.
Follow me on Instagram or Facebook and follow Uzazi Village as well. We have a monthly newsletter that you can sign up for that always informs on what we’re up to. We’re excited about the new documentary that’s coming out. We had a documentary that came out two months ago called Sister Doulas, and we have a new documentary that will be released next week called Pregnancy and Prejudice, and that’s on docucourse.org. That will be up on a website that you can see it at any time once it’s released.
We are excited that our work is getting noticed, that folks are paying attention to what we’re doing, that we’re really in a growth phase. I’ll be spending all afternoon interviewing doulas today because we’ll be adding more doulas to our staff. We currently have nine, and we’ll probably be adding five to seven more. The work is being done. It’s always lovely to be recognized, but even better if we’re having a positive impact.
RD: Big shout out to all your doulas and all the team members at Uzazi Village and the Ida Mae Center for the work that you do. It’s incredible. I’d also encourage our listeners to click on the get involved page and there’s a place for monetary donations and in-kind donations such as through a Target wishlist and an Amazon wishlist.
And as always, we try to encourage people, if you’re thinking about donating, to think about how monthly recurring donations are so much more impactful than a one-time donation if you’re able to give that way because people can then depend on those, even if they’re small.
HP: Yes, absolutely. We love our donors. Also, opportunities to volunteer. If you’re in the locale, we do volunteer training monthly. But yeah, I second your shout-out to our doulas. They’re really the heart of our work here, and our midwives, they do a phenomenal job taking care of our community.
RD: Awesome. Well, thank you so much, Hakima, for coming on the podcast, and we’re just so grateful for all the work that you do.
HP: Thank you for the invite. Thank you for the opportunity to share.
