NOTES FROM THE FIELD

Save 100 Babies�: Engaging Communities for Just and EquitableBirth Outcomes Through Photovoice and Appreciative Inquiry

Fleda Mask Jackson • Ama R. Saran •

Sharon Ricks • Joyce Essien • Kevin Klein •

Darryl Roberts • Natasha Worthy

� Springer Science+Business Media New York 2014

Abstract This paper presents a community engagement

model designed to advance social justice and equity for

African American birth outcomes through the combined

techniques of Photovoice and Appreciative Inquiry. In

response to the persistent racial disparities in birth outcomes,

Save 100 Babies� was constructed as a 2-day summit where

the emphasis was placed on individual and community assets

rather than deficits. The engagement was designed to create a

level of readiness among individuals working within and

outside the field of Maternal and Child Health to envision

strategies to attain equitable birth outcomes. The goal of the

conference was to facilitate higher level consciousness by

guiding the participants though a process aimed at articu-

lating assets, possibilities and the potential for co-creating

the desired future where racial disparities in birth outcome

are eliminated. As the result of the guided discourse that

began with photographs of the lives of African American

women, participants articulated the strengths they detected

from the pictures, their recommendations for multifaceted

changes in policies and practices, and their individual and

organizational commitments for a changed future. Since the

summit, participants have indicated ways they have fulfilled

their vows that include informing families and communities

about pregnancy risks, working with youth programs, sup-

porting fatherhood involvement in pregnancy and birth, and

advancing case management that is more attuned to women’s

strengths. Save 100 Babies� is evolving into a network and

clearinghouse for sharing and disseminating information and

resources for collaboration.

Keywords Black infant mortality � Health equity � Social

justice � Community engagement � Resilience and assets �Photovoice and Appreciative Inquiry

Introduction

We seek engagement through dialogue, leadership

development, collaboration, and new models of

organizing.

W. K. Kellogg Foundation [1].

F. M. Jackson (&)

Psychology Department, Spelman College, Atlanta, GA, USA

e-mail: fledamjackson@gmail.com

F. M. Jackson

Save 100 Babies, Atlanta, GA, USA

A. R. Saran

National Center for Health Behavioral Change, Morgan State

University, Baltimore, MD, USA

e-mail: ama.saran@yahoo.com

S. Ricks

U.S. Department of Health and Human Services, Region IV,

Atlanta, GA, USA

e-mail: Sharon.Ricks@hhs.gov

J. Essien

Rollins School of Public Health, Atlanta, GA, USA

e-mail: jessien@emory.edu

K. Klein

Uncharted Territories, Asheville, NC, USA

e-mail: uncharteredterritories@mac.com

D. Roberts

Mt Welcome Baptist Church, Decatur, GA, USA

e-mail: darryldroberts@gmail.com

N. Worthy

Atlanta Healthy Start, Center for Black Women’s Wellness,

Atlanta, GA, USA

e-mail: NWorthy@cbbw.org

123

Matern Child Health J

DOI 10.1007/s10995-014-1436-9

This paper describes a model of community engagement

used to advance health equity and social justice in the

crusade against the disproportionately high rates of black

infant deaths. The model focuses on capitalizing on indi-

vidual and community assets, rather than the stereotypical

challenges most often associated with black expectant

mothers and their newborns. Through the combination of

effective tools and other resources, the model demonstrates

a novel approach for convening individuals and organiza-

tions around the goal of ensuring that all babies are born

healthy.

Community engagement is ‘‘the process of working

collaboratively with and through groups of people affiliated

by geographic proximity, special interest, or similar situa-

tions to address issues affecting the well-being of those

people’’ [2]. Two of the most significant expectations of

successful community engagement are: (1) the establish-

ment of positions and strategies to guide empowering

interaction and (2) the mobilization of community con-

stituents for decision making and social action [2–4]. Thus,

for community engagement to advance the goal of social

action, it is essential that the process be constructed to yield

opportunities for mutual and empowering discourse.

To address the issue of black infant mortality, the

techniques of Photovoice and Appreciative Inquiry were

used to generate meaningful and constructive dialogue that

supplanted the customary ‘‘life deficit’’ discussions about

the reproductive outcomes of African-American women.

The engagement was designed to create a level of readiness

among individuals working within and outside the field of

Maternal and Child Health (MCH) to envision strategies to

attain equitable birth outcomes.

Background

In the spring of 2008, the documentary When the Bough

Breaks aired nationally as part of the award-winning Public

Broadcasting System (PBS) seven-part series, ‘‘Unnatural

Causes: Is Inequality Making Us Sick’’ [5]. The film illu-

minated the facts surrounding black infant mortality and

cast a spotlight on the issues for African-American moth-

ers-to-be in Metro Atlanta through its compelling illustra-

tion of the harmful effects of racial inequality on birth

outcomes [6–11].

In Georgia, African Americans experience the highest

rates of infant deaths: African American (12.3 % per

1,000), Whites (5.7 %), Hispanic, and Asian (3.8 %) [12].

Comparable to Georgia and the nation, the data for

metro Atlanta indicates that many African American

communities also experience disproportionately higher

rates of infant deaths. Atlanta, according to the latest US

Census Bureau Report has an African-American population

of 54 % [13]. Despite the area’s reputation as a hub for

racial progress—professionally, economically, culturally,

and socially—the data consistently shows that black babies

there also are twice as likely to die before their first

birthday [6].

The explanations for the racially disparate birth outcomes

are as multifaceted as they are challenging to comprehend.

Various studies have consistently linked racial stress to poor

health and well-being, which includes poor birth outcomes

[8–11]. Furthermore, research conducted in Atlanta con-

firmed racial and gendered stress’ (gendered racism) asso-

ciation and prediction for significant pregnancy risk [9, 11].

The imbalance of stressors, adequate support, and effec-

tive coping mechanisms have been established as significant

contributors to black infant mortality [9, 14]. Therefore, the

conditions that bolster individual resilience and community

resourcefulness hold promise for creating sustainable indi-

vidual and community-level interventions. In other words,

strategies for eradicating racially disparate birth outcomes

require a focus on creating the conditions necessary to pro-

duce birth outcomes that are both positive and equitable.

Health equity ensures that all people have access to what

is needed to obtain the highest living standards for optimal

health. It also embodies an intentional consciousness and

activation of the authentic knowledge that individuals and

communities hold to navigate their lives. Consideration of

the conditions under which people are born, grow up, work,

and age, e.g. the social determinants of health and the

systems of health care, are therefore critical factors in the

health equity equation [15, 16]. The growing emphasis on

the social determinants of health warrants a broad range of

expertise and insights for drawing the connection between

life experiences and health outcomes. This presents both a

challenge and an opportunity for designing approaches to

cross-sector engagement that is informed by empirical

studies on racial and gendered stress. Ideally, engagement

for just and equitable health outcomes must seek to enroll

cross-sector individuals and organizations in ways that

facilitate and capitalize on the mutual exchange of infor-

mation, knowledge, best practices, and recommendations

for effective transformation.

Community Engagement Through Photovoice

and Appreciative Inquiry

Advanced by Wang and Burris to inform and mobilize

individuals, communities, and organizations for change,

Photovoice was developed for small and large group

interaction. The approach utilizes photographic images to

elicit facilitated dialogue for identifying and interpreting

the experiences and/or settings that are most pertinent to

the participants’ lives [17, 18].

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123

Photovoice operates on the premise that images teach;

and that the interpretation of pictures, especially by those

populations most impacted by an issue, can direct action

and inform policy. Accordingly, the technique is an

effective tool for information gathering, participatory needs

assessments, asset mapping, and evaluation. Photovoice is

most suitable for uncovering women’s lived experiences

across life stages, and evaluating and addressing those

conditions impacting women’s health [19].

Wang and Pies developed a Photovoice process for

enhancing MCH agency assessment and evaluation that

used images and the interpretation of these images that

gave staff providers keen insights into community issues as

a context for their quantitative assessments [19]. In an

investigation on potential shared housing arrangements, the

photographed images and responses from intergenerational

African-American women suggested indications of con-

vergent experiences and relationship formation as the result

of their participation in the process [20]. Likewise, a

Photovoice study on lower-income women’s access to

healthy foods revealed not only the difficulties in obtaining

the food, but also the ways that women, nonetheless, felt

empowered to amass what they needed for their families

[21].

The conceptual frameworks for Photovoice are steeped

in Friere’s participatory action work and feminist/woman-

ist theories, emphasizing voice (empowered self-expres-

sion) for those populations most vulnerable to an issue

[22–24]. Friere and others have identified the levels of

responses oppressed people have to their lives. The lowest

levels reveal feelings of entrapment, helplessness, and

passivity. In contrast, the highest level demonstrates self-

efficacy and the readiness to act based upon the ability to

envision ones’ own contribution to a new future [20, 25].

The highest level response is best achieved when dialogue

is facilitated in ways designed to emphasize individual

assets and strengths.

Appreciative Inquiry (AI)—as the complementary

methodology used in this model—is a positive, strength-

based, group facilitation approach. The emphasis is on

helping individuals to see what works, as opposed to fixing

what is wrong. Created by David Cooperrider as a method

for organizational development, it has been applied to

businesses, government agencies, and religious institutions

[26, 27]. Its goal is to prevent individuals from feeling

helpless by energizing them through a focus on available

assets, possibilities, and their potential influences in co-

creating their desired futures.

The questioning in AI revolves around four foci: dis-

covery, dream, design, and delivery [28]. Beginning with

interviews and narratives in which participants describe

optimal performance and functioning within their settings

(discovery), the conversation is then directed toward future

possibilities (dream), visioning for achieving those aims

(design), and identifying plans of action (delivery). It has

been asserted that AI presents a promising approach for

addressing the issues of health disparities in a manner that

has greater possibilities for sustainable change [28].

Designing Save 100 Babies�

Save 100 Babies�—a translation of the Atlanta-based

research on assessing racial and gendered stress –was

successfully presented and well received at a summit

conference. The conference initiative was conceived to

generate community engagement, ignite emphasis on

individual resilience, uncover community resourcefulness,

and identify the changes in practices and social policy

required to address MCH health disparities [29, 30].

The conference also was designed to ensure that the

experience extended beyond unidirectional presentations to

encourage attendee participation. Discourse was promoted

through the facilitated processes of Photovoice and

Appreciative Inquiry, which were adapted for a conference

format. The use of these two techniques was a formative

encounter. Attendees with a broad spectrum of knowledge

and experiences were brought together to identify the

possibilities for their individual and collective contribu-

tions to changing the status of black infant deaths.

The title of the conference was derived from projections

of the number of babies that could be saved in Metro

Atlanta counties if the rates for preterm deliveries in

individual counties were reduced by 50 %. Held at and co-

sponsored by Atlanta’s historic Ebenezer Baptist Church,

the setting underscored black infant mortality as an issue of

social justice; human and civil rights; and a moral obli-

gation that can only be remedied through a multi-layered

approach.

Participants and Procedure

More than 100 women and men of diverse backgrounds

participated in the summit, representing a broad spectrum

of urban communities and health care, education, housing,

employment, social service, faith-based, and advocacy

organizations and agencies. Many of the participating

individuals and organizations represented the professional

and community networks of the summit planning com-

mittee and presenters.

Marketing efforts for the conference included the

widespread distribution of brochures, flyers, and e-mail

invitations emphasizing the event’s focus on equity and the

social determinants of birth outcomes. Before the day of

the summit, the Center for Black Women’s Wellness, a

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123

summit co-sponsor, distributed disposable cameras to their

clients, asking the women to photograph and create journal

entries about a day in their own lives to include images of

themselves that illustrated the settings in which they car-

ried out their lives. These women were individuals from

the community surrounding the Center who were enrolled

in the Healthy Start program, or clients eligible to enroll in

the Center’s wellness clinic.

Institutional review board clearance was not required for

this conference; however, prior to the event, the women

signed forms granting permission for their pictures to be

shown during the summit. Black and white photos were

enlarged to poster size with excerpts from the journals

printed on them and prominently displayed throughout the

conference venue.

Note takers/scribes were assigned to record and reflect

on the participants’ responses to the Photovoice images and

to the battery of AI questions they were asked. Notes were

then analyzed to determine the themes that emerged from

the conversations.

The Process

The summit agenda incorporated a variety of components,

each designed to elicit and disseminate information of

critical value in helping the participants achieve their

shared goal. The scheduled agenda was:

1. An introductory presentation that outlined the goal of

the conference

2. A viewing of the documentary, When the Bough Breaks

3. An overview of data relating to black infant mortality

4. Facilitated small group sessions guided by Photovoice

and Appreciative Inquiry

5. Large group sessions for sharing the discussion from

the small groups, and

6. A panel discussion that focused on MCH practices and

policies

Facilitated Small Group Sessions

Appreciative Inquiry (Discovery)

Introductory sessions began by asking attendees to talk

about why they came to the summit. Subsequently, the

participants were divided into pairs and asked to identify a

specific time when they felt cared for and loved. Those

conversations were followed by sessions in which the

participants were divided into groups and shown the pho-

tographs with the journal entries hidden.

Photovoice and Appreciative Inquiry (Discovery

and Dream)

Participants were then asked to provide responses to the

photos. They also were prompted to comment on the

images by elaborating about what they saw that could have

a positive impact on pregnancy and birth.

In the first session, participants responded to a woman’s

photograph of her nearly empty pantry, which she descri-

bed as:

The pantry is basically bare. I do have my cereal that

I get off of WIC vouchers and pretzels. Everything

else in there is phone books, trash bags, and alumi-

num foil. I know that my mother wonders why we are

always at her house to eat.

The second photo depicted a preschool boy sitting on a

neatly covered bed, pillows at his back with a blanket

bearing the name of a college folded across his lap. His

mother’s comment:

This is the bed my son and I share. He’s getting

bigger and likes to move around a lot where neither

one of us gets a good night’s sleep because we are

both uncomfortable.

Second session attendees viewed a pregnant African-

American woman gazing over a park while seated on the

landing of a wooden playground structure. She wrote:

Me? Seven and a half months pregnant wife and

mother of a two-year old, just thinking about the

difficult things that my family and I are going through

right now.

The second photo in this session was an image of two

slightly crumpled dollar bills with several coins scattered

across them. The woman who took the photo wrote:

Money is very low. I’m unable to work and my

husband is working as hard as he can to get a job to

take care of his family.

Photovoice Higher-Level Responses and Appreciative

Inquiry (Design, Delivery)

The conversation about the images continued with the

participants being asked to express how they saw them-

selves, their communities, and the organizations partici-

pating in the quest for equitable birth outcomes. The

session ended with members of the group being asked to

articulate their individual and collective commitments to

ensuring that babies are born healthy.

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123

Outcome: What They Said

Appreciative Inquiry and Sharing Their Lives

(Discovery)

Participant responses included the following comments and

revelations:

I came to be a voice for children: one woman, one

baby at a time.

As expressed by this participant, black infant mortality

was seen as a social justice issue. While venting frustra-

tions over the lack of progress, participants also articulated

a commitment to change:

[I]want to do something different in terms of strategy;

things are getting worse.

Individuals also expressed their desire for more informa-

tion and networking opportunities:

I want to understand the problem from a gender,

racial and human perspective;

[I want] to connect with others who want to do better

in combating this problem.

The two-person conversations revealed periods when

participants had received support and encouragement from

family and friends during crises and as they worked toward

particular goals. Their sharing provided indications of them

feeling empowered and self-confident as a result of the

support they had received.

Photovoice and Appreciative Inquiry Responses

(Discovery and Dream)

A Toddler Seated on a Bed

Seeing a child and a mother sleeping in the same bed

(co-sharing) does not remind me of abuse. In my

culture, children and mothers share the same bed.

There are cultural differences; so, different cultures

may think different about things.

Another participant, however, disagreed with this

perception:

Abuse may be an issue, since the child and mother are

sleeping together in one bed; He may witness the

sexual experiences of his mother.

Others viewed the picture as evidence of stability, order,

and educational aspirations:

The blanket on the bed has the name of a college; this

is a positive image for the family. The mother may be

pursuing a college education. Seeing the name of a

college and knowing there is a focus on education

may be very motivating for the children.

A Pregnant Woman in a Park

She is well dressed; a woman of hope.

Was she poor? Session members challenged this

assumption, principally because of the way she was dres-

sed. They also viewed her being married and her children

having a father living in their home as positive:

The family is intact. While unemployment may be an

issue, the importance of the family must be

remembered.

Still, other observers interpreted the woman’s forlorn

expression as signaling stress, hopelessness, and guilt about

her being unable to work.

Two Dollars and Some Change

All agreed that the picture of the two one-dollar bills and

coins symbolized poverty and the stress of income

inequality:

Should some people have to be underpaid? A person

is doing everything to try to have a good life, but

wages are low. As a country, we have a moral obli-

gation to help the families that are struggling. Low

pay is intentional. Minority employees see others get

the promotion, but they work just as hard. It causes

stress.

An Empty Pantry

The picture of the food-bare pantry also was seen as

indication of income inequity. Yet, once participants were

made aware of the mother’s social support, the fact that she

and her children often had their meals with her mother who

lived in the neighborhood, one response was:

At least she has a family nearby to go to.

What Do Women, Men and Families Need to Produce

Healthy Babies? (Design)

Social support and the presence of needed resources were

viewed as foremost for producing positive birth outcomes.

The conversations centered on interventions for reducing

the stress for expectant mothers and fathers. Regarding

prenatal care and the attention on emotional health, one

individual asked:

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123

Is there a set of questions that OB/GYNs ask during

prenatal visits that would help referrals for mental

and physical health?

Participants recommended stress reduction classes and

other support resources to alleviate psychosocial pregnancy

risk.

The discussions about the impact of pregnancy on men’s

lives examined their contributions to healthy birth out-

comes. One participant noted that the effects of pregnancy

loss on men is seldom explored, asserting that:

Men should be as equally supported as women.

The Role the Black Church

The role of the Black Church in ameliorating the stress and

strife as women await the birth of a child was the focus of

much of the dialogue. Understandably, given the location

of the summit, faith-based organizations were named

prominently as key sites for attending to the emotional and

instrumental needs of pregnant women. As sanctuaries

where the attributes of the individuals are routinely

affirmed, still more can be done to nurture and care for the

needs of pregnant African-American women.

A discussion ensued; affirming and challenging the

institutional role and responsibility of the Black Church to

address the social determinants of birth outcomes. The

consensus that arose from this discussion was:

The church must continue to be, said one of the

participants, the place where people can go to get

what they need…[we must] reintroduce the church as

an integral support system for pregnancy and birth via

mothers, aunties, neighbors, members.

Referencing pregnancy and birth within a religious context,

one individual commented:

Use [the church] as the sacred space model as pre-

vention for infant mortality; pregnancy as a life cel-

ebration; honoring the process through rituals;

recognizing the women’s/mother’s need for time out.

Likewise, the role of public and private institutions, such

as the workplace and educational institutions (K-12), were

also the subjects of engaged discourse. The recommenda-

tions included permitting longer maternity leave and

making certain that all school-age children have mentors.

What Will You Do? (Delivery)

The transition into commitments for changing the land-

scape of black birth outcomes began with conversations

about the innumerable possibilities for families and com-

munities. Participants stated they would educate family and

community members about the seriousness of black infant

mortality and the importance of healthy living, including

finding ways to reduce racial and other stressors.

Creating healthy communities in the participants’ own

neighborhoods and churches was viewed to be among the

ultimate goals. Thus, they expressed a willingness to

advocate for the creation and maintenance of resources

within African-American communities. For example, one

individual committed to supporting teenagers by providing

challenging experiences through outdoor exploration,

camping, water sports and leadership training sponsored by

the Boy Scouts, churches and associated counseling

services.

Political activism, beginning with grassroots organizing

for educating politicians about black infant deaths was

tethered to commitments addressing housing, work, and

income inequality. Connecting the work of citizen advo-

cacy to critical public health issues also was clearly

articulated.

For employment and fair wages, one recommendation

was to re-examine the Davis-Bacon Act involving public

finance wherein union-scale wages or higher-than-mini-

mum wages are an integral part of job creation.

According to one of the participants, this approach rep-

resents a strategy where marketplace and economic issues

converge and require government intervention to make it

possible.

Individual participants and agency representatives

offered ways in which they might redirect their profes-

sional work. The commitments included:

• A local district health department representative ded-

icated his agency to enrolling 75 % of the pregnant

women in his district into prenatal case management to

serve as additional support, while a national govern-

mental health organization committed to collaborating

on grassroots activities for healthy pregnancies.

• A nonprofit organization devoted to hurricane recovery

vowed to address infant mortality during and in the

aftermath of natural disasters by making certain that the

needs of expectant mothers were systematically

addressed.

• A shelter for homeless children saw its contribution as

serving as the liaison between the shelter and any

persons or programs that support improving the

economic, educational, health, and the social well-

being of all babies and their families.

• The Georgia State Department of Labor pledged to

coordinate the development of informational hands-on

tools and resources for participants to get people trained

and back to work.

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123

• Participating professors saw their institutions as sites

for teaching students about the impact of social,

political, and economic factors on birth outcomes.

Social work students in attendance articulated the need

to research and develop new curricula for community

health workers, while other students committed to volun-

teering to work with expectant mothers to help alleviate

their stress. Sororities and other civic and social organi-

zations explored how they might incorporate reducing

black infant mortality into their agendas. Lastly, the rec-

ommendations for prenatal care centered on the holistic

approaches employed by midwives and doulas operating in

rural and urban sites who would train local community

people to implement short- and long-term prenatal care

strategies.

Discussion

The responses resulting from the combined tools of

Photovoice and Appreciative Inquiry demonstrated their

utility for translating a social justice and health equity

agenda for healthy babies into action. Photovoice tell us to

look—up close, and personal. The techniques of Appre-

ciative Inquiry direct how to look in consideration of assets

and the strengths. Their inclusion in a model for commu-

nity engagement was productive in fostering high-level

responses: participants first articulated their own successes

and supports as catalysts for recognizing the possibilities in

the lives of others. What transpired as the result of the

images and facilitated discourse was a model for uncov-

ering the context and work of social justice and health

equity pertaining to the elimination of racially disparate

birth outcomes.

Save 100 Babies� was designed as a starting point for

encouraging the readiness of cross-sector participants to

advocate and act upon the health equity and social justice

agendas for black infant mortality. Explicit in the use of

Photovoice, and the adaptation of Appreciative Inquiry,

was the belief that the goal of health equity should com-

mence at the highest level of mutual community discourse

for the exchange of information and ideas. It was through

the iterations of the AI questioning, moving from discovery

through to delivery, provided a pathway for participants

might to envision how they might contribute.

Admittedly, everyone in attendance was not initially

engaged at a high level of consciousness in visioning the

transformation for others. However, the documentary,

When the Bough Breaks, and the Photovoice images served

to enlighten the audience about the widespread incidence

and effects of infant mortality throughout African-Ameri-

can communities. Many were astounded to learn of the

cumulative impact of racism experienced over a lifetime

and how it can have a profound effect on birth outcomes

that outweighs the benefits of higher social, class, and

economic status. The images left no doubt that black

women from all walks of life are at risk for poor pregnancy

outcomes. Consequently, the responses revealed a critical

array of social, economic, and cultural assets and recom-

mendations for interrupting the linkages between poor birth

outcomes, poverty, and racism.

The participants noted the priority of social support,

resources, and information for mediating stress across their

family, community, work, and constituency networks.

Resiliency and resourcefulness within families and com-

munities were confirmed as essential for a changed future.

Participants touted personal attributes and most acknowl-

edged their presence in the lives of the women portrayed in

the photographs they had viewed. There was shared rec-

ognition that individuals who were vulnerable to poor birth

outcomes were in possession of authoritative knowledge

that could be applied to ensure healthy birth outcomes.

Social policy and community organizing for decent and

affordable housing, fair wages, and job creation were all

viewed as essential to saving babies lives. It was recom-

mended that what was learned from the summit about the

social determinants be incorporated to direct and expand

the scope of the work being done at agencies and organi-

zations serving expectant women and their babies.

Unlike the application of AI for existing organizations

and programs, the process was adapted for a limited

community engagement, with little possibility or intention

to evaluate the extent to which participants honored their

vows after the conference. Attendees gave high ratings

indicating that the summit exceeded their expectations for

learning about the issues and for the receiving guidance for

uncovering solutions.

Since the summit, some participants have anecdotally

reported progress on the commitments they made. While

the focus of the conference was on adults, some individuals

have reported increasing activities with youth as a means to

promote leadership and health for pregnancy prevention.

Other programs are expanding to support fathers’

involvement during pregnancy and birth. Housing profes-

sionals are reporting their continued advocacy for living

spaces where families can thrive. Social service agencies

and health care providers indicate expanding their capacity

for case management in ways that are attuned to women’s

strengths and their needs. The news about what individuals

and organizations are doing is being conveyed through the

evolving network Save 100 Babies� has become. The

initiative is developing as a clearinghouse for sharing and

disseminating research, information, and resources for

collaboration.

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123

Conclusion

The discourse confirmed the value of an approach for

community engagement that advances individual and

community assets, the social determinants, and most

important social justice and health equity. Their integration

signaled that the moral imperative to confront the crisis of

black infant mortality is as vital as those aims steeped in

social, economic, political and health agendas. Ultimately a

social justice and health equity agenda is a vision wherein

the needed changes exceed racial parity to reach the

highest standards for health and birth outcomes. [23].

Future iterations of the approach will pursue further pos-

sibilities for engaging cross sector communities around the

concerns of racial and gendered health equity for policy

and practice development and implementation.

As we continue to advance the willingness and capacity

of individuals and organizations to provide the infrastruc-

ture, resources, and support systems necessary for the

healthy birth outcomes of African-American babies, we are

encouraged and guided by the words of Dr. Martin Luther

King, Jr.:

The arc of the moral universe is long, but it bends

toward justice [31].

We remain in pursuit of justice.

Acknowledgments We would like to acknowledge the W. K.

Kellogg Foundation and HHS, Region IV for their generous support

of this work. Thank you to Reverend Dr. Raphael G. Warnock for

welcoming the collaboration with historic Ebenezer Baptist Church.

We also express sincere gratitude to Jemea Dorsey, Director of the

Center for Black Women’s Wellness and most especially the center’s

clients who permitted us into their lives and became the beacon

guiding the direction for just and equitable birth outcomes.

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