From Detroit to Kansas City: Adapting the WE CARE Model to Improve Maternal and Infant Health.

Abstract

Background: The United States lags peer nations in infant mortality, with persistent racial and geographic inequities. In Missouri, Black infants experience mortality rates more than double those of White infants. Addressing these disparities requires community-driven interventions beginning before conception and extending beyond routine perinatal care.

Objectives: We describe the development and feasibility of Women & Person-Empowered Community Access for Reproductive Equity (WE CARE)-Jackson County (JC), a reproductive justice-informed intervention adapted from the Detroit WE CARE model to address reproductive health and infant mortality disparities.

Design/setting: WE CARE-JC used a two-phase, mixed-methods design. Phase 1 included listening sessions with advocacy groups and reproductive-age women, and a community survey (N = 537) to identify needs, barriers, and engagement strategies. Phase 2 piloted the intervention in a safety-net hospital's emergency department. Intervention components included the "One Key Question," MyPath decision-support tool, community health worker-led counseling, and follow-up care navigation.

Results: Listening sessions identified trusted providers as preferred sources of family planning guidance, while stigma, limited provider access, and knowledge gaps were key barriers. Survey data showed social (13% housing, 22% food, and 35% transportation insecurity) and medical (51% comorbid condition) vulnerability. In the pilot, 45 women were enrolled (85% of those approached), of whom 58% scheduled follow-up care and 10 (39%) attended appointments. Feedback from eight attendees showed high acceptability of the MyPath tool, counseling, and navigation support.

Implications for health equity: WE CARE-JC demonstrated feasibility and acceptability of a reproductive justice-informed, community-engaged model to reduce barriers and improve equitable access to reproductive health care. This model provides a scalable framework for addressing upstream drivers of infant mortality inequities.