E107: Building Better Black Maternal Health with Hakima Payne

Birth should feel safe, familiar, and centered on the family—yet too often the system delivers the opposite. We sit down with nurse, doula, educator, and Uzazi Village founder Hakima Payne to trace how personal experience scales into community clinics, data-driven policy, and a blueprint for culturally rooted prenatal care. From the early days when “doula” wasn’t a household word to today’s Medicaid reimbursement wins, Hakima shares what’s changed, what stalled, and what’s getting worse for Black maternal and infant health.

Together we unpack the difference between doulas and midwives, why VBAC remains restricted across many hospitals, and how routine inductions became normalized without consistent shared decision-making. Hakima explains why race-specific data is essential to make disparities visible, how policy lags behind evidence, and what it takes to convert awareness into funding, regulation, and accountability. We also talk candidly about the insurance industry’s outsized influence on bedside care and clinician autonomy, and why clinicians employed by hospital systems may have less power to bend the rules than many assume.

The heart of the conversation is a model: community-embedded prenatal care. Think accessible clinics in the neighborhoods they serve, culturally concordant teams, and integrated services—midwifery, doulas, lactation, chiropractic, herbal support—wrapped in details that signal safety and belonging. For parents, we share practical steps to shape their birth experience and ask better questions. For doulas, nurses, and providers, we outline how lifelong learning, anti-racism training, and cross-setting collaboration can move outcomes. Stay for a grounded call to action that keeps momentum alive even when media attention fades.

If this conversation resonates, follow the show, share it with someone who cares about maternal health, and leave a review with the one change you want to see in birth care. Your voice keeps this movement growing.

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Show Credits

Host: Angie Rosier
Music: Michael Hicks
Photographer: Toni Walker
Episode Artwork: Nick Greenwood
Producer: Gillian Rosier Frampton
Voiceover: Ryan Parker

Transcript

Meet Hakima Payne & Uzazi Village

SPEAKER_00 0:09

Welcome to the podcast. With a lawyer. Will we help prepare folks for labor and earth? Expertise coming from use of experience and busy. Helping thousands of people prepare for labor. Providing lighting tools and labouring experiences and hello and welcome to the Ordinary Doula podcast.

SPEAKER_04 0:51

This is Angie Rogier, and I have a very special guest with me here today. Her name is Hakima Payne. She is the founder and former CEO of Ustazi Village, which is located in Kansas City, Missouri. And I know Hakima as so many things to me. Um dear friend and mentor, and so fortunate to have her here with us today. So Hakima, will you further the introduction a little bit? Tell us a little bit about yourself and your work.

From Doulas To Systems Change

SPEAKER_02 1:21

Well, thank you, Angie. I'm delighted to be a part of your show. Thank you for the invitation. For those who are unfamiliar with Uzazi Village, it is a nonprofit organization. It's a 501c3 that's focused on primarily on black um maternal health, maternal and infant health, and um at various times we had a doula agency. We've always done doula training. The organization currently has a prenatal clinic and primary health care clinic. And we provided a number of services to our black urban community there in Kansas City, such as a breastfeeding clinic, diaper distributions, uh breast milk exchanges, just so many other services over the years, uh childbirth education. Um and so we did quite a bit of work around black maternal health and uh the subsequent researching of our work and our outcomes that went with it. Um so it it started out as primarily doula work and mushroomed into so much more because then you had to work with state legislatures to get laws passed, you had to work with state regulators to um get regulations updated. Uh we worked for several years to get our doulas in the state of Missouri reimbursed by Medicaid, and and that finally occurred. And even now we're currently working on legislation to update our birth center regulations in the state because the organization would like to be involved in in starting an urban birth center. So um we pioneered uh training Mendulas to work with other fathers, um and work with researchers across the country who were doing work that was specific to black maternal and infant health issues. So we've um we've had a broad swath of involvement and a lot of issues related to black maternal and infant health.

SPEAKER_04 4:23

It sounds like over time um your projects have grown and grown.

SPEAKER_02 4:29

And continue to do so, even though I am now retired. I've been retired from Uzazi Village for a year now. Um, but look back with great pride on on the work that we did then and that's continuing to go on now.

SPEAKER_04 4:47

Yeah. So looking back over your career, which has had many facets to it, what are some of your lessons learned with looking back? What are some of the the top lessons that you have learned in time?

Wins And Stalls In Maternity Care

SPEAKER_02 5:03

Well, there's so many. I I started out first as a childbearing person myself. Uh so I have nine children of my own, uh, six home births and three hospital births, uh, in the reverse order, had the three hospital births first, and then the last six were born at home. Uh from that work I became a doula and later became a doula trainer, um, but also went to nursing school, became a labor and delivery nurse, had a career at in labor and delivery. Um from there got my master's in nursing education and taught labor and delivery nursing for a time, um, and then left nursing to start my nonprofit uh about 14 years ago and did that work up until last December. So I've had quite a variety of experiences in maternal and infant health with many lessons learned. You've worn many hats. I've worn many hats. I would say it's important that each person find their area of passion and then just keep working away because progress is made bit by bit. And there's so much about our maternity care system, our health care system in general, that needs to evolve and improve.

SPEAKER_04 6:46

What changes have you seen in the last few decades? What are some of your favorite changes and what are some negative perhaps negative changes?

SPEAKER_02 6:55

There have been both because that's a that's the thing about life. You'll see the pendulum swing one way, but if you keep on living long enough, you'll see you'll see it swing back, and that's not always fun to watch. Yeah. Uh I do think that for certain the work that I've done and many others in this field have done have had an impact on the role of the doula, that now uh doula's are much more commonly known and understood. I think people still mix up the doula role with the midwife rule, but uh people do know the word doula, and that was not true when I started this.

SPEAKER_04 7:43

So you kind of got to see the rise of doulas as a professional.

SPEAKER_02 7:46

Yes, yes, I worked as a doula before we barely had the word doula. Um and so the rise of doula's seeing doula's get paid through Medicaid and private insurance, there there was definitely a time we thought we'd never see that. And and it is a now a lived reality. I I do believe all 50 states will eventually be reimbursing doulas. Um I I've also seen breastfeeding become more commonplace. I've seen breastfeeding numbers rise. I've seen the use of birth centers and other out-of-hospital birth uh places become more common. Um so there there have been some really positive changes. I'm still surprised that medical establishment still struggles with V-BEX. Yeah. They still are kind of poo-pooed in some places, outlawed in others. Yeah. Um, and that the C-section rate has stayed stubbornly high.

SPEAKER_03 9:16

Mm-hmm.

SPEAKER_04 9:17

With all our other pieces of progress, we haven't budged that one much.

SPEAKER_02 9:21

No, we haven't. So so they're and uh inductions have become much more ubiquitous. So there's so commonplace nobody even bats an eye. Uh people don't stop to question, wait a minute, what's the medical reason I'm being offered this procedure? Uh so there's a lot that has changed, and there's a lot that hasn't. That has stayed the same or even gotten worse.

SPEAKER_04 9:55

For the things that have changed in good ways, what do you think the drivers are for that?

SPEAKER_02 9:59

Is it people, is it policy, is it well, I think people drive policy and there has to be persistent pressure applied. And I think that that makes the difference if you keep an issue uh in the limelight. I mean sometimes things happen that you can't account for that may push an issue over the line. Uh but but that positive persistent pressure for change needs to be expressed. Um I don't think systems change without provocation.

Policy Pressure And Public Awareness

SPEAKER_04 10:42

Do you think it's people having babies that per push that change? Because so many come into it, it's new to them, they don't know the history, like or is it other workers in the field that are more co more familiar with the field that kind of push for change?

SPEAKER_02 10:59

I think it's both. Certainly you need your advocates and and if it's your calling to be an advocate, you you know, you pick your your issue and you stay on it and that persistent pressure. Uh but sometimes change comes because of huge consumer shifts and and in their desires and what they want in their care. And that can be a real driving force too. I was around when um LDRPs were a thing, if you remember the LDRP movement. Uh when I gave birth uh for the first time back when dinosaurs were on the earth, they moved you from a labor room and then into a delivery room and then into a recovery room and then into a postpartum room.

SPEAKER_03 11:57

Wow.

SPEAKER_02 11:58

Uh and so you just got moved from room to room. Each room was the size of a closet. Got room moved from one closet-sized room to the next uh for each phase of the experience, and it was really consumer demand that uh that uh drove the movement toward what they called at the time family-centered care, where they began to build the big suites and all of that took place in one room. Instead of being moved from room to room, from unit to unit, it all happened in one in one room, that that was driven by consumer demand.

SPEAKER_04 12:44

That makes sense. Can you think of anything else, whether uh world event or shifting, societal shifting that made changes from the consumer side?

SPEAKER_02 12:56

Well, I think that the whole issue that Uzazi Village stands behind, which is the issue of black maternal health, uh, that is an issue that that really began to get more attention, more policy change, and therefore more funding, uh, more from advocates, but also a few key nationally exposed cases. Yeah. Um like Serena Williams. Uh so some media events have helped. So yeah, and and um events like that, again, you can't plan them, you don't know they're coming, but they can be huge drivers for change. And I don't know that that changed anything, but it gave a lot of exposure to the disparities in black maternal health.

SPEAKER_04 13:55

Which it seems for a time was getting a lot of good attention.

Data, Disparities, And Backsliding

SPEAKER_02 13:59

Uh it was. So was becoming well funded, uh getting lots of media attention. Um communities were becoming more aware that uh there were disparities in black maternal health. Um, because you can't solve a problem that you don't know exists. So that awareness it's a first step, but it's a critical step. And yeah, there were definitely some some media events that uh gave uh national attention to the issue as a whole. And things like that can be very helpful. You just don't know when or where they're coming from.

SPEAKER_04 14:50

And have you sent some good change um by well people like yourself who do a lot of hard work? What else has has moved the needle on black maternal health?

SPEAKER_02 14:59

Uh I don't think the needle has moved on black maternal health. In fact, I think that's one of the areas where it's going backwards. Yeah, right now where the rates are actually worse than when we started. Yeah. Started. Um I remember back in 2012, 2013, uh there were lots of conversations about this and more careful attention paid and more data gathered and and now the data that we're seeing now is the numbers are actually getting worse again.

SPEAKER_04 15:34

Part of that's due to our current probably our current uh political attention.

SPEAKER_02 15:40

Because yes, they um are removing uh attention uh from issues um that might be racially or even sociologically driven. And so sadly that's to the detriment of outcomes and communities that are being affected. Um there's more awareness, uh, but awareness alone doesn't make for improvements.

SPEAKER_04 16:20

There has to be some action behind.

SPEAKER_02 16:22

Absolutely. There must be policy change. There has to be changes in the way funds are distributed, attention has to be paid to uh regulatory uh agencies that that oversee health outcomes. Um and all of that takes money, so funding has to be shifted. And and so there's real systemic changes that have to be made to really improve health outcomes. So consumers can demand it, but also sys systems have to make a space for solutions to occur.

SPEAKER_04 17:06

It's kind of a multifaceted solution has to come from several directions.

SPEAKER_02 17:11

It does. And it's not often that you see all of that work together to create the needed change. Uh but changes have happened. Positive movement has been made. Um, like I said, some things have improved, others have stayed doggedly the same, and and other things have gotten worse.

SPEAKER_04 17:39

So moving looking forward into the future, and I know your work um a lot of your maternal health work is done in your sh as you shift gears a little bit at this time in your life, but recommendations for those in the maternal space, especially maternal health disparities, what uh recommendations can you see that would be beneficial from a multifaceted approach?

Actions For Parents And Doulas

SPEAKER_02 18:04

Well, um I do believe that research is important. Um I'm a data person myself. Uh I believe health is or health outcomes is equal parts, arts and science. Um and we can't neglect the science part of health. Uh, I do think we need to be very careful about uh counting uh and about how we count um some of the movements that I hear about now want to ignore collecting data by race, but I think that's incredibly dangerous to do that. It's easy to hide the disparities that happen in neglected communities in greater data sets. Uh so if you don't break your data out by race, uh you may not even see the problem. The data may not even show you the problem. Uh so I continue to be an advocate for good data collection, uh, for understanding how important it is to to define and to count properly so that we actually see problems as they are occurring. Uh but even when we've got good data, we need to follow that up with productive policy. Um and policy can take a long time to change, but policy is driven by data can take a long time to collect data. It can take decades to collect data and and then another decade more to to shift policy. And then once the policy is shifted then again you have to to make sure that the resources are placed in the right place to continue the progress. So change can come uh it's often generational when you're talking about change on the scale of systems. But of course in the meantime individuals can create change for themselves that can be impactful for them. So an individual could choose to explore dietary changes can become more selective about their care provider, maybe choose midwifery care if they qualify for it. They could hire a doula they could choose a hospital or birth center or home birth for their place of delivery where they that they think will be most consistent with their birth plan. So there are also things individuals can do to to improve their course of care and maybe improve their health outcomes um but um I'm typically working on the on the scale of systems which are can be much harder to shift.

Nurses, Providers, And Bias

SPEAKER_04 21:46

Right. Systems are big ships that are hard to hard to make change with. So s I love what you talked about in what individuals can do and exploring their options is definitely one knowing that they have options. Exactly it's key how about um on a doula level what could a doula do to improve some of these outcomes and create this system wide change how can do's do that so I I believe firmly that doulas should be lifelong learners.

SPEAKER_02 22:23

I know when doulas are new when they're new to the profession they lean a lot on their own personal experience but you really want to move beyond that because your own personal experience is very very limited so keep learning keep growing that way you can better educate your clients and better serve your clients the more you know so make sure that you're well educated about the particular institutions in your community that you know what the resources are available in your community so that you can steer your clients um to to whatever's a better fit for them. You know if there's a birth center in your community go visit it. Go meet the midwives who work there same for the hospitals in your community if you have hospitals that do maternity care in your community go visit them go do the do the tours. Take a class at your local community college on on um physiology that you understand how birth occurs and and um all your body parts. So I think doulas play a fantastic role, a great role in positive health outcomes uh but that can also vary doula by doula. So keep educating yourself, keep learning more so that you can pass that learning on to your clients because clients um if they don't know their options then they don't have any.

SPEAKER_04 24:19

How about um you because you have worked in this role maybe this is a tricky question how can nurses make positive change? They're deeper in the system.

The Insurance Squeeze On Care

SPEAKER_02 24:29

Nurses are deeper in the system but I also see nurses as your friend on the inside. Yeah yeah uh nurses are empathetic and um and their job is to care. Uh they are a trusted healthcare professional um but so despite them being embedded in a an imperfect system um I think your nurse may be your your best hope for an empowered birth uh so I think both those things can be true at the same time. I would my caution to nurses uh working within systems is to be aware of their own biases. I still highly recommend anti-racism training for all healthcare providers and and so that they're they're serving each uh community according to their specific needs uh and you know typically nurses have the education they have the knowledge and they're the experts uh and they know what what they're doing they know how birth works they understand how the body works um it's the cultural awareness piece that may be lacking for nurses if they're serving community members from communities that aren't their own I like that I see that a lot in hospitals that I work in where assumptions are made um that are not accurate and can be dangerous by um sometimes nurse level for sure by how they care for patients.

SPEAKER_04 26:25

So I like that how about next level providers in network providers or um providers at hospital how can I mean outside of hospital easy to make change because you're out of the system.

SPEAKER_02 26:39

Maybe easier yeah but I I would say you use the word bias I I would definitely say that applies to providers providers I I tend to see them um as more biased only because they providers tend to be embedded in a particular environment and they get comfortable in that environment and they don't understand the benefits or barriers of other types of birth environment. And it's a pretty limited environment right uh you might see it that way yes that you might the the options for how they perform their duties can be can be narrow and prescribed uh so I would say providers embedded in hospitals don't have a really good understanding of birth outside the hospital um I don't know that necessarily works the other way around uh usually providers who work outside the hospital have had previous experience inside the hospital uh but it doesn't work the other way around uh uh so I would invite them to learn more uh because they often are leaning on biases when it comes to understanding why someone might choose a home birth or why having a doula might be so important to a client or or how a community based midwife is educated and what her competencies his or her competencies might be a provider inside the hospital may not have a good understanding of those things.

SPEAKER_04 28:40

And providers it seems might have a little bit more power in the system than like nurses, right?

Designing Community-Embedded Clinics

SPEAKER_02 28:45

Would you say you would think I think that sh I think that's actually shifting. I think as more and more physicians work for hospitals they have less and less say. So you know it's a different model from what it used to be in the start of my career when when physicians form their own practices outside the hospital and then sought privileges that definitely still exist today but you see more and more become employees of the hospital system and which makes them more rule bound. So it's they they may not have as much power as you might assume to alter things or bend the rules. Yeah to make changes. Yeah so Tony And the insurance industry has shifted that a lot too as far as I'm concerned the insurance industry is kind of the devil incarnate when it comes to healthcare I don't think that industry has added to healthier outcomes but it certainly has added more regulation more restrictions they absolutely have a lot of control over how money gets spent uh I think they're the bane of providers I think they're the bane of institutions and patients I think they're the bane of healthcare consumers. Yeah so uh they they their shadow looms large over healthcare and I don't know that they uh provide a level of benefit commensurate with their presence in healthcare I can see that I believe that yeah they're a powerful a powerful entity that mostly benefits itself yes makes a lot of decisions for us unfortunately yes and so a lot of that freedom that you think providers have to to make clinical choices um is oftentimes overridden their hands are tied by insurance related issues.

SPEAKER_04 31:14

Yes interesting so how would if you were to um provide care or a a a program of care for a pregnant person what would be the and everyone will be a little bit different obviously but if we could in general speak to what would be available um what do you wish every pregnant person had available to them?

SPEAKER_02 31:38

I wish and this really hasn't changed my answer to this is a 30-year-old answer because it's the same way I've always thought that they would have individualized community embedded care so that they they could find the provider of the choy of their choice where they live in their own communities uh that they could seek prenatal care of their choosing in their own communities that they could be provided by uh cared for by those who were either members of their community or had been educated in the cultures of their communities but I I believe in community embedded care. I think for me that's a high hallmark that people don't have to leave their communities and don't have to be subject to cultural nor norms that are foreign to their own when it comes to birth care. And a lot of the work you did with your Salty Village helped provide that's exactly the model I followed because it's the model I believed in then and the model I still believe in um we uh created the Ida May Patterson Center for Maternal and Infant Wellness so we call it Ida May Center for short uh Ida May was my grandmother named named the clinic after her um but it is absolutely a community embedded model of prenatal care the the clinic is in the community uh in the black community of Kansas City where black folks live it's accessible by bus. The providers are black and brown people themselves they can get midwifery care can be assigned a doula can see a chiropractor and and a lactation consultant and an herbalist and just sort of get one-stop shopping all their cultural ways are going to be respected and embedded in the way that clinical care is provided and so there's going to be a lot of familiarity even down to details like the music that they hear. Yeah it's the same music they hear when they're in their homes. So um so I'm a big believer in community embedded models of care. Yeah but the power with the people kind of yes very cool so that people feel at ease because entering the healthcare system is um entering on a foreign environment anyway and um and it's not an environment that African Americans are completely trustworthy of so any we set as a goal to create an environment in which uh black childbearing individuals felt safe. And that's no small feat.

SPEAKER_04 35:14

Which does go down to the details as far as it absolutely everything in the room and the the food that you eat and the food the people the the pictures on the wall.

A Call To Birth Workers Everywhere

SPEAKER_02 35:26

The art yeah um yeah the design of the rooms yes we're a lot of paying the aesthetics all of it yeah a lot of our systems overlook some of those details for community groups. And because we were a small private albeit nonprofit clinic um we we could do things differently so uh when I was CEO our employees could bring their their infants to work with them for for the first two years. So when our clients entered the Ida May Patterson Center the first person they saw was N Nadira our office manager sitting at her desk by the front door with her baby on a living on her back she wore her baby. And that even that image alone you walk in yeah you're greeted by um a woman carrying her baby on her back and and who's an employee that just gives you a whole different view of the place.

SPEAKER_04 36:42

A sense of comfort. Yes familiarity amazing well Hakima as we wrap up our session any final thoughts you want to leave um at with of what we've talked about of lessons you've learned over your time as you look back on your career and the amazing work you have done?

Closing Reflections & Connection

SPEAKER_02 37:04

Well I'm I'm excited for the work that I've done but there's still so much more to be done and so I I just want to inspire the birth workers who are out there listening to this no matter where you are geographically no matter what um community or family types you're serving whether it's um minority communities, LGBTQ families rural families suburban families wherever you are whatever you're doing I want to inspire you that that your work is needed these issues are getting less and less play in the media and they've become a lesser part of the public discourse but babies keep on being born these issues are just as pertinent as they always were and I've definitely seen a shift in in the public discourse around maternity care but this isn't the time to slow down uh we've made positive change there's been some momentum and and even though um the attention that's given to these issues uh has shifted the importance of the work has not so I would just encourage your birth workers out there wherever they are whomever they're serving uh the importance of this work and to keep going keep doing it keep doing it keep the conversations coming keep the conversation going talking about it keep striving towards improvement for sure which there's a lot to do so as important as it always was yeah yeah that's perfect well Kima thank you so much for being here with us today yeah thank you for inviting me I'm delighted to be a part of your podcast and thank you for letting me have some time to have my say oh I appreciate it your your words are valuable to me and to many many others so we want to wrap up our episode of this this episode of our podcast with Hakima Payne um it's been wonderful to talk to her and as as always we encourage you to go out and make a human connection our human connections are important so reach out to someone you know or someone you don't and make someone's life a little better today.

SPEAKER_00 39:33

Thanks for being with us and we'll see you next time thank you for listening to the Ordinary Doom Podcast with Angie Rosier hosted by Berth Morning episode credits will be in the show notes. Tune in next time as we continue to explore the Many aspects of giving birth.