ST. LOUIS — For the last 12 years, Lora Gulley has been advocating for maternal and child health for underserved St. Louis families. As Generate Health director of community mobilization and Advocacy, Gulley collaborates with community organizations to improve the health and well-being of communities impacted by social and health inequities.
“My focus and interests are ensuring those most impacted by racial disparities have a voice in shaping issues impacting their health and well-being,” said Gulley.
Generate Health’s vision is to zero racial disparities in infant and maternal mortality by 2033.
Gulley's career spans over two decades helping improve the overall health of impoverished communities. Gulley believes that maternal and child health are key indicators to judge the overall health of a community.
According to the director, maternal well-being impacts the health of future generations, and she is committed to giving all St. Louis children a healthy start. The St. Louis American had the opportunity to talk with the director, and she discussed her frustrations with the health field and solutions that can help close the maternal health gap.
St. Louis American: Describe Generate Health STL and the services it provides
Lora Gulley: Generate Health is a coalition that brings together diverse stakeholders from community, non-profit, for-profit, government, and academic institutions to address some of the region’s most pressing maternal and child health issues. Our collective power aims to advocate for racially equitable policies and practices, centering, supporting, and celebrating Black families throughout their pregnancy and parenthood journeys.
The Bloom Network is a collaborative effort that provides quality care through home visitation, perinatal behavioral health, and safe sleep resources. These resources are critical drivers of maternal and infant health disparities.
Generate Health has developed a model of resident-driven leadership that governs our initiatives. Our approach is to support the leadership of those with lived experience – from FLOURISH’s Community Leaders Cabinet using their voice to shape maternal and infant health policy and systems to the Black advocate-led Missouri MOMNIBUS Steering Committee crafting a package of policy recommendations designed to significantly improve Black maternal health disparities in Missouri.
SLAM: Why did you enter the field of maternal health?
Gulley: Despite advances in medical care in St. Louis, Black women are still three times as likely to die around the time of pregnancy than white women and over 84% of those deaths are preventable. The voices of those most impacted by racial disparities are often left out of decision-making roles and I am committed to ensuring the community has a voice in shaping the systems and policies to help families grow and thrive. By working to ensure Black families and communities have the support they need to be healthy and that systems are equitable and allow everyone a just opportunity to achieve healthy outcomes.
SLAM: What alarms you concerning maternal health in women of color?
Gulley: St. Louis is unconcerned that Missouri is one of the most dangerous places to give birth in the country. Giving birth in Missouri is too often a battleground for Black birthing people and their babies. Toxic stress, barriers to healthcare, and other social determinants impact the survival rates of both moms and babies during their first year of life. Disturbing new data from the CDC show an increase in the nation’s infant mortality rates for the first time in twenty years, with Missouri cited as one of four states (Iowa, Georgia, Texas) experiencing significant increases (16%) in infant mortality. According to the latest Pregnancy Associated Mortality Report, the pregnancy-related death rate increased from 25.2/100000 (2017-2019) to 31.8/100000 (2018-2020) with mental health conditions cited as the leading cause of pregnancy-related death.
SLAM: How can we as a community shrink the health disparities gap?
Gulley: Improving Black maternal health outcomes demands a multi-faceted, holistic approach that addresses Black women’s health across the lifespan, improves access to quality health care, addresses social determinants of health (improving family and community conditions), and provides greater economic security: Providing patient-centered care that is responsive to the needs of Black birthing people, expanding and protecting access to trusted community providers, expanding access to quality, patient-centered, and comprehensive reproductive healthcare, addressing the social determinants of health (conditions under which people live, work, and play), expanding paid family and medical leave.
SLAM: How can women advocate for themselves during doctor visits?
Gulley: Simply put, know before you go. Women should seek out evidence-based information on pregnancy, birth, and postpartum so that they know what to expect and can be aware when something is not right. We also must be bold and seek second opinions or change providers when we are not being respected and listened to. Lean into your community to find providers that Black and Brown women have positive experiences with. Until providers are held accountable by the medical boards and society, the community must hold them accountable and not stay with or recommend harmful providers.
Having a trained advocate like a doula as a part of the process makes an impactful difference. Doulas can have a wide range of skills and knowledge that help birthing people navigate their experience from pre-pregnancy through postpartum (after birth). While doulas are not the fix to the maternal health crisis, they improve the experience and outcomes of birthing people and their families.
SLAM: What postnatal care does Generate Health STL provide?
Gulley: The BLOOM Network, an initiative of Generate Health, exemplifies our collaborative approach, co-creating an equitable system of support for home visitation, prenatal behavioral health, and safe sleep for Black pregnant and parenting families. Addressing factors that contribute to toxic stress such as substance use, intimate partner violence, trauma, and maternal care providers and organizations that meet social needs. BLOOM also works at the systemic level to advocate for increased access to transportation, housing, and food.
In March, Generate Health will launch its Community Leadership Fellows training that will equip 12-15 community residents with lived experience to participate in decision-making roles to build collective power to influence maternal and health policies and drive systemic change.
Ashley Winters is a Report for America reporter for the St. Louis American.