Maternity health clinic owner and public health expert Getty Israel is still on a mission: to open Mississippi’s first freestanding, midwife-run birth center.
Should she be successful, Mississippi would join neighboring states such as Tennessee, Louisiana, Arkansas and Florida in providing an alternative to giving birth in a hospital setting for pregnant women who are low-risk. The birth center would also be a place for women to receive prenatal care from certified nurse midwives as well as postpartum support.
But after nearly a year working to secure funding for her nonprofit Sisters in Birth to open the center, she’s come up short – and she blames what she calls an unfair and unclear federal funding process funneled through the state’s members of Congress.
Israel applied for federal funds through a lesser-known program called Community Project Funding in which constituents can request their senator or representative recommend their projects for funding to the U.S. Senate Committee on Appropriations. Only nonprofits are eligible for the funds, and lawmakers must also certify that they and their immediate family members do not have a financial interest in the organization.
She said despite providing ample evidence of the benefits of birth centers and midwife care to mothers and babies, plus a letter of support from State Health Officer Dr. Dan Edney, Republican U.S. Sens. Roger Wicker and Cindy Hyde-Smith – whom she refers to as “so-called pro-life” – and Democratic 2nd District U.S. Rep. Bennie Thompson did not refer her project for funding.
However, they did request funding for projects for nonprofits with millions in net assets and hired lobbyists – a point with which Israel, whose organization reported around $5,000 in negative net assets on its most recently available tax form, took issue.
“You should see the waste on the list. I identified 13 large, wealthy organizations, which primarily receive the bulk of this recommended funding for fiscal years 2023 and 2024 – they have total net assets of tens of millions of dollars,” she said. “Several of these organizations aren’t in Mississippi.”
She said small nonprofits in Mississippi desperately need funding but may not be aware of how to get it, much less successfully get on any congress member’s recommended funding list.
“There are thousands of nonprofit organizations in Mississippi; the majority are small and struggling to provide crucial services to Mississippians. These organizations likely have never heard of these federal earmark programs because our congressional members fail to promote it,” she said. “Consequently, only corporations with relationships to legislators or their staff will know to apply.”
Information about Community Project Funding is on each Congress member’s website, along with a page dedicated to information about applying for federal grants. General guidance for applying for Community Project Funding is online.
Neither Wicker nor Hyde-Smith responded to questions for this story. In an emailed statement, Thompson said no favoritism is given to particular applications but declined to answer specific questions.
“Each application stands on its own,” the statement said. “The federal government considers supporting a variety of federal programs. However, this application wasn’t selected through the (Community Project Funding).”
Wicker’s office requested $1.5 million for a D.C.-based group called Reading is Fundamental Inc. to implement a childhood literacy program in Mississippi. His office also recommended sending $997,000 to a group called Save the Children, also located in D.C., for a project that would provide learning resources to children and families in rural communities in the state.
Wicker is not the only Mississippian to steer funding to Save the Children – the well-regarded humanitarian organization also received TANF money from the Mississippi Department of Human Services in 2017. In 2021, Gov. Tate Reeves awarded the organization $460,000 in pandemic relief funds, and the organization also receives funding from the Mississippi Department of Education for literacy, nutrition and fitness programming in the schools.
Hyde-Smith’s requested projects for fiscal year 2024 included everything from $7 million for a road project in a wealthy area of Madison County to millions for training programs at universities and community colleges to $4 million for water supply improvements for the city of Byram.
In fiscal year 2023 – the year for which Israel first applied for funds through Thompson’s office – his office requested hundreds of thousands each to cultural projects like the Community Museums of African American History and Culture Project in Belzoni and the Catfish Row Museum in Vicksburg. Also on the list was $2 million for the construction of a new clinic in Greenville.
A 2018 evaluation of a federal study of health and cost outcomes for mothers and babies on Medicaid showed women who received care in birth centers had better outcomes – including lower rates of preterm birth, low birthweight and fewer C-sections compared to other Medicaid participants with similar characteristics. Those in the study who received midwife-directed care at a birth center also cost an average of $2,010 less than their Medicaid counterparts.
Israel believes such a clinic would improve maternal and infant health outcomes by minimizing medical interventions and reducing Mississippi’s first-in-the-nation C-section rates. Midwives’ holistic approach, she said, could also have a positive impact on the state’s high rates of preterm and low birthweight babies.
There are currently about 400 birth centers open and providing care in the U.S., according to the American Association of Birth Centers. Mississippi is one of only eight states that does not have a birth center.
Jill Alliman, a certified nurse midwife who is on the board of directors of the American Association of Birth Centers, said birth centers are especially equipped to handle pregnant women with social risk factors such as mental health challenges, lower education levels or a history of domestic violence – common challenges in a community like Jackson.
Alliman said the presence of a birth center and the midwife-centered care that comes along with it could be “life changing.”
“I think that in states like Mississippi that have so many challenges with maternal and infant health, there needs to be a big effort to increase access to the midwifery model of care and to offer options for birth center care because it’s part of the solution,” she said. “We can see that doing what we’ve been doing for so long is not working.”
Mississippi’s maternal mortality rate is worsening, the latest data shows. The rate increased from 33.2 deaths per 100,000 live births in the time span of 2013 to 2016 to 36.0 deaths per live births from 2017 to 2019.
The worsening rate disproportionately impacts Black women, who had a rate of 65.1 deaths per 100,000 live births – more than four times the ratio for white women.
“The (maternal and infant health) outcomes are deplorable in Mississippi. Over the last 50 years, those numbers just seem to get worse,” Israel said. “ … Midwives put an intervention in place. She’s looking at the whole person and treating the whole person.”
State Health Officer Dr. Daniel Edney echoed Israel in a letter of support he wrote for Israel’s birth center, calling it “change that cannot wait” in Mississippi.
“As you know, many women in Mississippi are unable to access prenatal care and adequate labor and delivery options that are safe for both mothers and babies,” he said. “… The use of birthing centers, with affiliations with critical access hospitals, is one of those evidence-based options that has demonstrated success in improving health outcomes for mothers and babies.”
Officials with the Mississippi State Medical Association declined to respond when asked for the organization’s position on birth centers.
Israel has shifted her approach: she is now reaching out to private organizations for fundraising. She has also produced a documentary about birth disparities in Mississippi that she is promoting nationwide to raise awareness about the issues facing Mississippi and to let people know they can help by donating money to build a birth center.
She said she’s found an ideal location in the medical district in Jackson and plans to purchase it.
However, In the meantime, women are driving to Memphis and Baton Rouge for birth centers, she said.
“I’m done looking inside the state of Mississippi. I’ve knocked on many doors – corporations, foundations, city and local governments … There’s no (financial) support in Mississippi, but I know women want this. I’m not driven by these so-called leaders. I’m driven by what women want.”
Clarification 5/24/23: This story has been updated to attribute a statement to U.S. Rep. Bennie Thompson.