This week, we continue highlighting some of the newest Health Equity Fund (HEF) recipients. The HEF—which is administered by the Richmond and Henrico Public Health Foundation and supported by the City of Richmond and RHHD—announced its most recent round of funding at the end of January.
At its heart, health equity is about recognizing when our existing care and social systems fail to reach and serve particular groups of people. It’s a practice of asking, “who’s missing from this picture?” when we talk about health and well-being in our communities.
For founder Sara Zia and the team at Virginia Prison Birth Project (VAPBP), some of the people who are most invisible in healthcare spaces are pregnant people and those who’ve recently given birth while incarcerated. “This is the most vulnerable segment of birthing people in our state,” she says. “Reproductive health equity, it’s not just the right to have a baby or not, it’s also the right to have a baby in a safe way and to feed your gestating fetus adequately and to house yourself. It’s so much larger, and it matters to the work we do because this population is hidden.”
Women are the fastest growing proportion of people incarcerated in Virginia’s jails and prisons. Estimates suggest that up to 12,000 pregnant people are incarcerated nationally each year, although no agency keeps an official count. These pregnancies are at high risk for complications because of limited access to healthy nutrition or prenatal care among other factors. And in Virginia and nationally, Black residents are overrepresented in incarcerated populations, which compounds disparities in maternal health and mortality for Black women.
Like all doulas, VAPBP’s doulas are trained to make sure that a pregnant person’s voice is heard both before and during labor. Because they work with clients in prison, VAPBP doulas do this advocacy and support work in both medical and carceral spaces. The organization began in the Charlottesville region, where Sara and her doula team created cohorts for 12 weeks of education, nutrition, movement classes, and emotional support before clients give birth. In these sessions, they talk about the anatomy and physiology of pregnancy, fetal development, prenatal care, childbirth while incarcerated, separation, lactation, parenting from inside, and reunification as a parent.
As VAPBP expanded services into Henrico County Jail, they also worked with the sheriff to bring in nourishing and familiar foods. Sara thinks that enjoying a meal together before class contributes to good nutrition and creates a “convivial” space for the group. And the cohort model is key: “Each cohort can form a pretty tight unit, especially at the prison because they live together and so it’s huge when one of them [gives birth]. We know the others are thinking of them and are ready to receive them when they come back—they know what it’s like.”
When incarcerated pregnant people give birth, family members are not present, so the doula functions as needed support and a familiar face. And they also help clients navigate a painful “separation visit,” where they say goodbye to their newborn before returning to prison. When people who are incarcerated give birth, they usually have only a day or two with their newborn before the baby goes to family members or other caregivers. “It’s so hard to prepare for that, but we help smooth things out and facilitate communication between the hospital, the prison, and the family and client in that space,” Sara says.
VAPBP doulas will often make sure the parent has spent time with a soft blanket that goes home with the baby and that the parent gets to keep the baby’s first warm hat. This way, both have something that smells, comfortingly, like the other. Sara explains that “helping to establish that connection and advocating for clients to be treated like human beings is worth all the struggles of working within this institutional framework. We aim to nurture clients’ connections with their babies however much we can within the constraints of giving birth in custody. Thinking of creative ways to do this comes naturally to our doulas.”
One of the most necessary things about VAPBP work is expanding efforts to reach each individual client while also keeping in mind the systemic changes—in sentencing and incarceration, in addiction and substance use treatment, in mental health care—that could address these challenges at their roots. From Sara’s perspective, “The biggest problems are community problems that will take a community solution.” She cites prison nursery initiatives that keep mothers and children together for longer as a step in the right direction: “We need facilities that house mothers and babies so that they have a chance to catch their breath and we can come in and hear from them what their needs are.” And, she says, “If we want to have alternatives to incarceration that are not punitive but more compassion-based, we have to use evidence-based practices to genuinely promote wellness and talk about the whole system of health equity.”
As part of its efforts to address this range of community needs—from maternal health to substance use to food access—Health Equity Fund support will cover comprehensive doula work for 25 new BAPBP clients in Richmond City. Support includes weekly perinatal education, movement classes, and doula advocacy during and after childbirth. And with each client VAPBP serves, and each time Sara shares this work, the picture of our health equity landscape becomes a little clearer.
If you’re interested in learning more about or supporting the work of VAPBP, you can visit their website. VAPBP continues to look for restaurant partners willing to provide comforting meals during the training sessions and for support to send additional doulas to Prison Doula Certification training. You can also return to our blog for conversations with other HEF recipients, including Daily Planet Health Services and Gateway Community Health.
