In 2022, Independence Blue Cross (IBX) began working with Cayaba Care to help improve maternal health outcomes for our most at-risk members, particularly Black and Brown people. Cayaba provides support for people during and after pregnancy, to help them overcome some of the challenges that increase their risk of maternal morbidity and mortality.
In 2024, Dr. Adaeze Enekwechi joined Cayaba as the company’s new Chief Executive Officer. Recently, I sat down with her to ask about the vision and strategies she has for Cayaba, and I’d like to share highlights from our conversation.
Promoting Equitable Maternal Care
Dr. Ross: Tell us about your background and your interest in maternal health.
Dr. Enekwechi: I’m a health policy and economics professional by background. In addition to working in the private sector, I spent many years in government, including serving as head of health programs for President Obama at the White House Office of Management and Budget. I’ve spent my career making sure resources are being spent and directed in ways that ultimately make a difference in people’s health and well-being.
When it comes to maternal health outcomes, I’ve stopped quoting statistics on how badly the United States is doing. Suffice it to say, it’s shameful that a country this wealthy is performing as poorly in this area as developing countries.
And some of the most vulnerable people are women who look like me. Often it doesn’t even matter what their income and education levels are, as long as they’re Black or Brown.
Personally, I know this struggle from every perspective — through my direct experience, my work, and my education. And I’m just as terrified of these bad outcomes as anybody else. So it’s an honor to have an opportunity to try to solve this huge issue with Cayaba.
Dr. Ross: What are the challenges people of color face in accessing equitable maternity care?
Dr. Enekwechi: When you’re a person of color, in some ways the health care system is just not equipped to hear you. We call this implicit bias…but sometimes it’s not implicit, it’s just plain bias. It’s explicit.
Even Black women physicians often report being actively dismissed, ignored, and gaslit when they have health issues — even though they actually have the medical training to articulate what they’re experiencing in terms that other providers understand. So imagine how it is for someone who doesn’t have the vocabulary to describe their health problems!
Sometimes you just need someone to tell you that everything is going to be okay. But Black women tell me, “Nobody ever thinks to say that to me.”
Establishing Trust Is the “Secret Sauce”
Dr. Ross: How is Cayaba addressing these challenges?
Dr. Enekwechi: Effective health care ultimately comes down to a couple of things. It’s local, it’s based on trust, and it’s based on empathy.
That’s what Cayaba’s Maternity Navigators bring. They’re deliberately hired from the communities they serve. So our clients feel like they’re talking to someone who hears them, can connect with them, and, importantly, gives them agency, helps them frame their questions as they interact with their obstetrician.
But Cayaba provides a lot more — like lactation consulting. Recently a man told me, “After my wife had her baby, having a lactation consultant wasn’t just support — it was a mental health intervention.” These new parents based their whole self-worth on being able to breastfeed their baby. And because their baby wasn’t able to latch on and wasn’t feeding, things started to go awry pretty quickly. We were quick to intervene before things got worse, and it helped the dad as well as the mom. Lactation support meant everything to them.
We also make durable medical equipment very easily accessible, like breast pumps. Where appropriate, we equip our clients with blood pressure cuffs, train them in using them, show them how to record their readings. We teach them how to really take care of themselves in ways that most of us may not learn at home.
Dr. Ross: How does Cayaba select its staff?
Dr. Enekwechi: We hire people from the community, medical assistants and community health workers, and train them in the Cayaba Care model. Our Maternity Navigators are all doula-certified — we facilitate that training. But we also screen them for empathy. The people we hire for these roles speak the language of those they are caring for, they understand them.
The reviews we get from people who work with our Maternity Navigators say, “I trusted her. She trusted me. She held my hand. She was never condescending. She respected me.”
That’s what we bring. That’s our secret sauce.
Going Where the Need Is Greatest
Dr. Ross: How does Cayaba work with providers like obstetricians, midwives, and nurse practitioners?
Dr. Enekwechi: We are in Philadelphia, where many people giving birth are at high risk for poor outcomes, and we talk with health care providers. Providers are our partners; they refer their patients, we share data with them, we have an active partnership with them. Provider practices know their patients could use wrap-around services and support. We show them that we can help prevent NICU visits, maternal morbidity and mortality, and preterm deliveries. We have the data to back that up; we have real evidence.
Our kind of support is not something pregnant people are accustomed to because it usually does not exist. We need our providers to tell them, “Hey, talk to Cayaba. Engage with them and see. This could be quite useful to you.”
Dr. Ross: What are your immediate and long-term goals for Cayaba?
Dr. Enekwechi: I don’t want anyone who could be working with us to not be working with us. That’s my goal. There are too many women we know, too many people and families, that would hugely benefit from Cayaba’s support. And they deserve it. That’s my big goal, to serve all the people and families we should be supporting. I also want to deepen and expand our partnership with IBX, and serve our members over a long period of time as a member of this community.
Spread the Word
Health outcomes are unacceptably poor for pregnant people of color. That’s who is at the at highest risk for poor outcomes. We strongly encourage them to take advantage of this service, which is available at no cost to IBX members, as well as our other maternal health resources and services.
If you, or someone you know, might benefit from this kind of support, please contact Cayaba. Everyone deserves the best possible chance of a healthy and successful pregnancy, delivery, and postpartum period.
