Research
Data collection & analysis
Research
Data collection & analysis
Over the past two years, several researchers conducted surveys, focus groups, and key informant interviews with community-based birth workers to better understand their barriers, needs, and priorities. Some of these research projects were informed and conducted by this team, and others by partner organizations.
These studies highlighted different barriers to the growth and sustainability of community-based birth options. We need to understand these barriers so we can build an effective strategy to overcome them.
Community-Based Workforce Survey (A)
Researchers:
Nicollette Moore, MPH, Star August Ali, CPM, LM, ASM, CD, Nora Kropp, CPM, MPH, Kiarri Kershaw. PhD, MPH
This study explored positive and negative factors impacting community-based perinatal work, compensation and benefits, work-related stress, policy advocacy, and use of data. Respondents included community-based perinatal providers working in a high maternal risk counties and have expertise in one or more of the following sectors: abortion/reproductive health services, birth center services, community health workers, doula care, home birth services, home visiting, lactation support, Medicaid services, mental health services, midwifery care, migrant health, and support of people who use substances. These non-generalizable findings helped inform the content of the Community-Based Birth Justice Summit.
Corresponding author: Nora Kropp nora@blackmidwiferycollective.org
Illinois Certified Professional Midwife and Doula Workforce Landscape Analysis Report (B)
Researchers:
Camille Williamson, PhD, LCSW
Editing support: Anna Yankelev, MPH, MBA
Survey Design Team: Mekazin Alexander, Chastity Mays, M.S.Ed., CD(DONA), Star August Ali, CPM, LM, ASM, CD, Nora Kropp, CPM, MPH
This environmental scan of the doula and CPM workforces in Illinois documents client demographic information, the scope of services offered by doulas and CPMs, professional development opportunities, compensation, experience with Medicaid enrollment, and integration in formal healthcare settings. Findings include recommendations to expand community-based birth care throughout the state.
Corresponding author: Camille Williamson camillewilliamson1@gmail.com
Doula Training Provider Landscape Assessment (C)
Researchers:
Mayra Diaz, MPH, MSW
This assessment catalogues Illinois’ existing doula training programs, identifies barriers and gaps, and proposes policy and practice solutions to strengthen and expand the doula workforce in Illinois. Findings discuss training formats, trainee demographics, curriculum content, professional development supports, certification assistance, and other relevant aspects.
Corresponding authors: Anna Yankelev ayankelev@hmprg.org and Mayra Diaz mdiaz@hmprg.org
Community Birth Study (D)
Researchers:
Chanell Haley, PhD, Star August Ali, CPM, LM, ASM, CD, Nora Kropp, CPM, MPH, Nicollette Moore, MPH, Kiarri Kershaw, PhD, MPH
This study aimed to document and amplify the lived experience of people in southeastern Chicago/Cook County living in maternal health deserts to better understand their awareness of and interest in midwives and community birth options. Results show a great unmet need in the community, as the demand for racially concordant community-based birth settings and the demand for midwives were three times that of the current available supply.
Corresponding author: nora@blackmidwiferycollective.org
A Study on Expanding and Strengthening Community Birth Options in Illinois (E)
Researchers:
Karie E. Stewart, MPH, CNM-FPA, FACNM
Data Collection/Research Support: Annette Payot, CNM, Ruth Nwatu, Lon Berkeley, and Gayle Riedmann, MS, CNM-FPA, FACNM
Editing Support: Emily Gallion, Shannon Sweetnam
This study highlights the importance of establishing a more robust and sustainable community birth infrastructure in Illinois by analyzing the current landscape, identifying challenges and barriers that hinder progress, and recommending policy and programmatic changes to support meaningful change. This report reveals disparities across communities in Illinois and recommends several strategies to address these issues.
Corresponding author: Karie Stewart kariestewart@melanatedmidwives.com
Closing the Gaps: An Assessment of Maternal and Child Health Workforce Needs and Priorities in Southern Illinois (F)
Researchers:
Claire Hughes, MSW, LSW, Lundy Longoria, MPH, Tracey Smith, DNP, PHCNS-BC, MS
This study assessed the maternal and child health (MCH) workforce in Southern Illinois. Results showed high short-term commitment and professional confidence, but also revealed significant stress, burnout, and retention concerns linked to retirement and systemic instability. Participants identified urgent needs for increased funding, better provider collaboration, patient outreach, culturally competent services, and integration of community-based roles.
Corresponding author: Claire Hughes claire@littleresource.org
DREAM Study (G)
Researchers:
Nicollette Moore, MPH, Kiarri Kershaw, PhD, MPH
The Dismantling Structural Racism to Promote EquitAble Maternal Health Outcomes (DREAM) study seeks to better understand the impacts of structural racism in healthcare and community settings based on the perspectives of Black pregnant and postpartum birthing people, leaders and front-line workers of community-based organizations, and community-based perinatal providers. The overall goal of this project is to create a set of community-centered, actionable targets that reflect the lived experiences of Black birthing people and can be targeted to reduce the negative impact of structural racism on maternal health equity.
Corresponding author: Nicollete Moore
nicollette.moore@northwestern.
Key Findings
Racism and discrimination hurts birthing people and community-based birth workers alike.
- Over half (54%) of doulas and almost all (89%) of CPMs have experienced discrimination in health care settings.B
- Nearly half (42%) of community-based birth justice workers identified that secondary trauma stemming from their birthing clients’ experiences made it more difficult to carry out their work.A
- More than a quarter (28%) of community-based birth justice workers reported that witnessing racism at work made it more difficult to carry out their work.A
- Over two-thirds of respondents from a survey of birthing people in Southeastern Cook County completely or mostly agreed with the statement, “I believe providers in Cook County treat white pregnant women with more respect than pregnant women of color.D
The current workforce does not have the size, support, or geographic and racial representation to sustainably meet the state’s needs.
- Access to community birth settings throughout Illinois is largely determined by race, income, and ZIP code — not by family choice or clinical need.E
- The vast majority of doulas and certified professional midwives are located in Chicago and collar counties, with very few in rural/downstate areas.B
- While two-thirds of doulas identify at Black or Latine, only about one-third (37%) report serving clients of their race most or all of the time.B
- In 2025, there were only 4 licensed CPMs of color in the entire state.E
- As of 2025, there are only 5 birth centers operating in Illinois. In order to ensure there is at least one birth center in each of the 40 obstetrical planning areas in Illinois, we would need an additional 35 birth centers.E
- Nearly half of the maternal and child health workforce in southern IL was uncertain about remaining in their current positions or service areas over the next five years.F
- Doulas and CPMs need living wages, childcare assistance, and other social/emotional supports to avoid burnout and sustain their work.A,B,E
- Training and professional development is expensive and difficult to access for many, particularly outside of Chicago/Cook County.B,C
Health and hospital systems and other community-based organizations don’t always know how promote or coordinate with community-based birth options.
- Most (60%) of doulas and all (100%) of CPMs surveyed have had challenges integrating into formal health care and hospital settings.B
- A midwife shared that when she called ahead to notify the hospital and provide clinical context, “they were fine with that… but they had no interest in collaborating with me. They did not want to talk to me. They did not report back to me. Hospital staff told [me] that if [I] wanted updates [I] can talk to the client, rather than being treated as a member of the care team.E
- Doulas and CPMs expressed challenges in knowing how to refer to and coordinate with social service providers serving their patients.B
- Over one-third (37%) of community-based birth justice workers reported that a lack of integration into the medical system creates significant barriers for carrying out their work.A
- Many community-based birth workers operate in hybrid or community-focused capacities, emphasizing the importance of interdisciplinary collaboration in maternal and reproductive health across Southern Illinois.F
People don’t know about community-based birth options, or how to find the right resource to meet their needs.
- Nearly all (94%) of survey participants from Southeastern Cook County gave birth at a hospital, but one-third (33%) said that community birthing spaces outside hospitals were ideal birth settings.D
- Many birthing people need support related to food, housing, transportation, and other determinants of health, but aren’t sure how to find or access those resources.B
- Staffing restrictions at hospitals in Southern Illinois resulted in more families leaving the area to deliver. These conditions not only increase patient hardship but also stretch providers who must navigate inconsistent referral pathways and regional variation in capacity.F
Current funding and reimbursement rates aren’t enough to grow and sustain the workforce and community birth settings like birth centers.
- Most doulas, CPM, CHWs, and other roles do not make a living wage.A,B
- “We don’t get paid time off… no insurance… no 401K… We have to absorb those costs personally, despite performing the same work as providers earning ten times as much… in a hospital setting.E
- Lack of funding is the biggest barrier to aspiring community birth workers looking to enter the field. Many students require financial aid and wraparound support for things like childcare, transportation, and rent during their training.B,C,E
- Many community birth workers report difficulty with navigating state certification and accessing Medicaid reimbursement for their services, and report that the current rates do not represent the full scope of their work.A,B,E
- Without increased reimbursement for labor support, equipment, and travel, midwives cannot sustainably serve Medicaid-insured communities or families who lack financial reserves either at birth centers or home births.E
- “We should be compensated appropriately for our labor — the system saves money because of us, but we can’t afford to serve the families who need us most.E
- Current reimbursement models actually discourage collaboration between hospitals and community birth providers: if a home or birth center labor requires hospital transfer, “that birth is going to finish in a hospital setting. So that hospital is going to bill for the birth… and we don’t get to bill for that time,” even though homebirth midwives provided all early labor management and made the appropriate transfer decision. “You don’t want the thought that if I transfer this person, I’m not even going to get the birth fee… but actually, that’s the way it is.E
Meet the Researchers
Camille R. Williamson, PhD., LCSW
Read Camille's Bio
In 2023 I completed my doctorate degree in social work at the University of Southern California. My focus area is the Black Maternal Health Crisis. And in my research, I conducted qualitative interviews to learn more about why birth inequities persist and what we can do to develop solutions for this problem. Thus far, I have learned so much about barriers at the community level in terms of access to quality care for marginalized birthing people; as well as challenges in our out-patient and hospital systems due to structural racism, inaccessibility, and generational trauma. I learned that public health officials need more time and intentional space with community members to garner their experiences, build respectful and trusting relationships, and determine sustainable solutions together. And most importantly, I learned that we need a community-centered approach to set reproductive health standards, address fragmentation within our health and human systems, and advance health equity through a coalition of providers, physicians, and birth justice champions. Most recently, I have been working on the Illinois doula and midwife landscape analysis with the Health and Medicine Policy Research Group. My role is to develop quantitative and qualitative research processes, collect and analyze data, and provide recommendations to the Illinois State Strategic Planning Committee. This research project will be paramount in helping healthcare administrators, providers, and community health workers to develop a stronger system for birthing people throughout the state by providing a baseline of information for data-driven decision-making for better health outcomes for birthing people. Although this is a challenging wicked issue, we have exciting opportunities to make pivotal improvements in the lives of those most marginalized. I am excited to see that the Illinois Department of Public Health is centering health equity to address the social and structural determinants that impact our most vulnerable populations. Given the priority areas of chronic disease, COVID-19 and emerging diseases, maternal child health, mental health and substance use disorder, and racism as a public health crisis we have a long road ahead of us to charter; however, I believe in this vison, and I am committed to this field of work as a thought leader, change agent, and collaborator for better maternal child health outcomes and population health overall.
Kiarri Kershaw, PhD, MPH
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Kiarri Kershaw is a social epidemiologist whose research focuses on understanding and addressing structural and social drivers of health and health inequities. She has extensive experience in the application of advanced geospatial and statistical methodologies using several large maternal and cardiovascular health cohort studies. Dr. Kershaw also has multiple federally-funded studies that involve primary data collection using ecological momentary assessments to examine associations of the places people go, who they spend time with, and everyday stressful experiences with various health behaviors and outcomes.
Karie E. Stewart, MPH, CNM-FPA, FACNM
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Karie E. Stewart is a practicing Certified Nurse Midwife with the University of Illinois Mile Square Health Centers and the University of Illinois Department of Obstetrics & Gynecology. She has been a midwife for 6 years and is the current President of the ACNM Illinois Chapter Affiliate. Karie E. Stewart has been newly inducted as a Fellow of the American College of Nurse-Midwives in 2023. Karie E. Stewart received her master’s in nursing from the University of Illinois Chicago and her master’s in public health at Southern Illinois University Carbondale. She started a nonprofit organization in 2019 known as Melanated Midwives which aims to financially support BIPOC student midwives through their midwifery training programs with the goal of diversifying the midwifery workforce.
Nicollette Moore, MPH
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Nicollette Moore has a master’s degree of public health with a concentration in maternal and child health and program evaluation. She has over six years of experience leading and supporting maternal and reproductive health equity projects in the private, public, and academic sectors. Nicollette currently works at Northwestern University’s Feinberg School of Medicine leading the day-to-day tasks of a community-centered maternal health research project overseen by Dr. Kiarri Kershaw.
Chastity Mays, M.S.Ed., CD(DONA)
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Chastity Mays is co-administrator for The Little Resource Center Carbondale and has held formal doula certification for 6 years. She has been working in family service and peer-support spaces for over 15 years. She has served clients in Southern Illinois, the Missouri Bootheel area, and Paducah, Kentucky. She stands with and advocates for families who are underrepresented and, in many cases, simply not heard at all. Among the many committees and councils, she is a part of Chastity sits on the boards of the Carbondale Public Library and the Birth Equity committee for the Southern Illinois Healthcare Labor and Delivery Unit at Carbondale Memorial Hospital in Carbondale, IL. Chastity is routinely involved in state and regional political efforts around Black Maternal Health and frequently presents her expertise and experience in public forums, conferences, and through legislative testimony. Chastity believes that representation and cultural awareness is vital to changing the exorbitant black maternal mortality rates. She also sits on the Promoting Vaginal Birth Committee with Southern Illinois Healthcare. When she is not furthering her education or supporting families, Chastity enjoys spending time with her three children, two of whom are now in college, so she loves to travel to go visit them. She also enjoys reading, hiking, crocheting, and the theatre.
Star August Ali, CPM, LM, ASM, CD
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Star August Ali—known affectionately as Sister Star—is a Black midwife, mother of four, systems-change strategist, and nationally recognized leader in birth justice. She is the Founder and Executive Director of the Black Midwifery Collective (BMC), a Black-led nonprofit based on Chicago’s South Side dedicated to transforming maternal health outcomes as hospital systems continue to fail Black mothers at alarming rates. Through her work, Star advances culturally congruent, community-rooted care while reviving ancestral Black midwifery traditions that have sustained families for generations.
A descendant of a Grand Midwife who practiced in the 1940s, Star’s path into midwifery was guided by courage, legacy, and conviction. She trained as a Certified Professional Midwife (CPM) while practicing underground in Illinois for three years—at personal risk of felony charges—so Black families could access safe, culturally resonant, out-of-hospital maternity care. Today, she is one of only four Black Certified Professional Midwives currently licensed in the state of Illinois.
Recognizing that inequitable outcomes were rooted in broken systems—not individual choices—Star became a legislative advocate to confront obstetric racism and policy barriers head-on. She played a pivotal role in advancing multiple maternal health and systems-level bills through the Illinois General Assembly. Rising through leadership within the Illinois Council of Certified Professional Midwives (ICCPM), she became its first President of Color. Within six months of her presidency, Illinois achieved a historic victory with the passage of the Illinois Midwifery Practice Act of 2021, legalizing Certified Professional Midwives after more than 40 years of failed legislative attempts.
Under Star’s leadership, BMC has since reached another historic milestone: the creation of the first Certified Professional Midwife (CPM) degree program in Illinois, developed in partnership with Kennedy-King College. Approved by the Joint Curriculum Development
Council (JCDC) of the City Colleges of Chicago, the program is scheduled to enroll its first cohort in Fall 2026. This landmark systems-change initiative is designed as a national model and intends to be:
- The first midwifery school in the United States located within a predominantly Black community
- The first MEAC-accredited direct-entry midwifery program in Illinois
- The second CPM direct-entry program in the U.S. housed within a community college
- The only urban, public midwifery school in the nation offering access to financial aid
Star’s historical systems-change work provides a scalable roadmap for other states seeking to grow, diversify, and sustain the community midwifery workforce through affordable and accessible CPM education.
She is also a co-author of BMC’s Community Birth Study Report, which documents and uplifts Black birthing experiences across Illinois, and is featured in the award-winning documentary With Woman, recipient of a Grierson Award for its groundbreaking portrayal of birth justice and community midwifery.
Star has collaborated with advocate and actress Tatyana Ali to bring national visibility to this historic project and has worked alongside Reverend Jesse Jackson and the Rainbow PUSH Coalition to combat educational redlining in Chicago—efforts that were instrumental in realizing the CPM degree program.
As Chair of the inaugural Illinois Midwifery Board, Star continues to shape state policy, strengthen professional standards, and build a sustainable pipeline of community midwives. She has shared her expertise nationally at institutions including Bastyr University, Midwives College of Utah, Northwestern University, the University of Illinois Chicago, Southwest Technical College, Commonsense Childbirth School of Midwifery, and more. Her work has been featured in The Guardian, Crain’s Chicago Business, The Chicago Tribune, NPR, and other major media outlets.
Star’s work is grounded in a singular truth:
The solution is systems change.
Nora Kropp, CPM, MPH
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Nora Kropp is a Certified Professional Midwife (CPM) and a maternal health researcher with a Master’s in Public Health and a Bachelor’s Degree in Global Studies. Ms. Kropp has worked in the fields of women’s reproductive health and global health for 30 years. Nora has worked as an apprentice midwife in Nepal and as a CPM in a home birth practice in the US. Nora got her midwifery training at Maternidad La Luz in El Paso, Texas and worked in family planning and abortion services at Planned Parenthood in Chicago, IL.
She has experience with all aspects of research and program implementation in maternal health. Her
areas of expertise are: ethics in public health research, evidence based practice, abortion, quality of care, respectful care and the Midwifery Model of Care. Nora has lived in and worked on maternal health research in the US, Mexico, Nepal and India. As a maternal health consultant for RTI International, Nora worked with the Global Network for Women and Children’s Health Research on projects in India, Tibet, Argentina and Uruguay. Nora lived in India for ten years during which time she co-founded the Bangalore Birth Network where she and her colleagues incubated a freestanding birth center. From 2009 – 2015 Nora served as a member of the Ethics Committee at the Indian Institute of Management, Centre for Public Policy in Bangalore. Nora has worked with the Holistic Birth Collective in Chicago, IL focusing on reproductive and birth justice. Nora currently lives in Wilmette, IL where she enjoys life with her partner and two teenage daughters.
Anna Yankelev, MBA, MPH
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Anna joined Health and Medicine Policy Research Group in January 2023 where her work sits at the intersection of community organizing, strategic planning, workforce development, and health equity. She began as a youth activist, focusing on youth engagement and community organizing and furthered her passion for public health and social justice while earning her B.S. in Public Health from Brandeis University and her M.P.H. and M.B.A. from the University of Illinois at Chicago (UIC). After graduating, Anna joined the Lake County Health Department (LCHD) where she oversaw the development, implementation, and evaluation of the agency’s internal strategic plan and Community Health Improvement Plan. During the COVID-19 pandemic, Anna also served as the Chief Community Mitigation Officer for Lake County’s Public Health Emergency Operations Center (PHEOC) and developed and launched LCHD’s first Community Health Worker program. At Health & Medicine, Anna leads coalition building, strategic planning, policy advocacy and implementation, and other initiatives that support the development and sustainability of Community Health Workers, doulas, midwives, behavioral health workers, and other public health roles.
