In the United States, Black women face a staggering threefold higher risk of dying from pregnancy-related complications compared to white women, a disparity that transcends income, education, and healthcare access. Determined to change this narrative, Aza Nedhari co-founded Mamatoto Village. Since its inception in 2015, the organization has aided over 4,000 families in Washington, DC, achieving an impressive zero percent maternal mortality rate. Here, Nedhari discusses the essence of community-based care and its significance for Black women as a model for universal improvement.
Ashoka: Aza, could you share what motivated you to embark on this journey?
Aza Nedhari, Mamatoto Village co-founder
Magdalena Papaioannou / Mamatoto Village
Nedhari: My motivation wasn’t about identifying a gap in care; it was rooted in personal experience. I grew up in a close-knit community, so when I became a parent, the absence of that supportive network was palpable. This personal loss inspired the creation of Mamatoto Village. I met Kathryn Hall-Trujillo, founder of Birthing Project USA, and through her training met my co-founder, Cassietta Pringle. Together with several volunteers, we spent a year assisting teen mothers in Washington, DC. We encountered resilient individuals but also recognized unmet needs in housing, safety, and food security—issues beyond our financial and infrastructural capacity to address. This realization led Cassietta and me to establish Mamatoto in 2013.
Ashoka: How have you managed to sustain a zero percent maternal mortality rate among your clients?
Nedhari: Our success lies in our community-based home visiting initiative, Mothers Rising, operating since 2015. With over 4,000 families served and no maternal deaths, the program thrives on culturally informed, relationship-centered care delivered by a dedicated and skilled team. Our support system encompasses home visits, education, mental health, nutrition, social needs navigation, lactation, and high-risk care management. We adopt a Three Generations Approach, focusing on the intergenerational aspects of health, well-being, and social stability. Additionally, we have developed a community-driven perinatal care management system that merges clinical care with social needs on a unified platform.
Ashoka: Could you elaborate on how you’re expanding the healthcare workforce and the training involved?
Nedhari: We’re addressing the national healthcare workforce shortages by training individuals from the communities we serve. Participants are credentialed as perinatal community health workers, community doulas, or lactation consultants. We’re also establishing a midwifery track for those aspiring to become certified professional midwives. The training is comprehensive, featuring a rigorous didactic component, competency assessments, a certification exam, and fieldwork hours. We are also seeking accreditation for our training programs from nationally recognized institutions.
Ashoka: What are some widespread misconceptions regarding this issue?
Nedhari: One major misconception is that this is solely a poverty issue. Economic status alone doesn’t account for the disparity, as Black women with higher education and income levels still face higher mortality rates than less educated, lower-income white women. Another is that better healthcare access will resolve the problem. Research shows that Black women’s pain is often underestimated and their symptoms misattributed to non-clinical causes, leading to poor outcomes despite having good insurance and quality care. It’s also mistakenly viewed as a lifestyle choice issue. Arline Geronimus’ “weathering” theory describes the cumulative toll of racism on physiological health, highlighting the structural, not behavioral, nature of the issue. Moreover, the focus shouldn’t just be on mortality but also on severe maternal morbidity, which includes life-threatening complications not always tracked in places like Washington, DC, thus missing opportunities for intervention.
Ashoka: How do these misconceptions manifest in real-world scenarios?
Nedhari: These misconceptions influence policy decisions, funding allocations, and healthcare provider behaviors. When these misunderstandings are combined, they affect how care is accessed, experienced, and funded, leading to systemic issues. Correctly framing the problem is crucial, because addressing it effectively for Black women benefits everyone.
Ashoka: What changes do you envision by 2030?
Nedhari: By 2030, I hope to see the establishment of a birth and wellness center and a midwifery school, the first of their kind east of the Potomac River in Ward 7, Washington, DC. This $10-$15 million project requires partnerships and investment to ensure its sustainability. On a personal level, I hope for safe, supported, and respected experiences in pregnancy, childbirth, postpartum, and parenting. Systemically, I aim for community-based models like Mamatoto to be well-resourced and integrated into the health and social ecosystems, and for Black maternal health to be recognized as a universal concern, given that over 80% of maternal deaths in the US are preventable.
Dr. Aza Nedhari is an Ashoka Fellow. This interview was edited for length and clarity by Ashoka.
