What is clear is that D.C. has among the worst maternal mortality rates in the country. What is clear is that if you’re a black mother in D.C. you’re twice as likely to have a preterm birth than a white mother.

What is less clear is how to change these outcomes.

On Wednesday, medical providers, policy makers and community organizations gathered to tackle that goal at the district’s first-ever Maternal and Infant Health Summit at the Walter E. Washington Center.

Hosted by D.C. Mayor Muriel Bowser, days after she introduced the world to her 4-month old daughter, the summit focused on sharing best practices among local and national stakeholders, including mayors from Flint, Mi., Rochester, N.Y., and Gary, Ind. The event comes at an urgent time for the district, where maternity wards in two hospitals on the east side of the city closed within the past year, leaving many pregnant mothers in poor neighborhoods multiple bus rides away from the nearest hospital.

D.C. regulators shuttered the maternity ward and nursery at United Medical Center in Southeast after an investigation found numerous errors in treatment for Somesha Ayobo, a pregnant woman who died soon after being admitted to the hospital. That was weeks after Providence Hospital in Northeast also closed its maternity ward.

But one of the key dilemmas facing the players at the conference dealt not with access to hospital delivery rooms, but rather with the months of a woman’s pregnancy leading up to childbirth. According to the 2018 DC Perinatal Health and Infant Mortality Report, about half of black women and more than 1 in 3 Hispanic women are not entering prenatal care until their second or third trimester or not receiving care at all.

The issue is not insurance, Bowser said, since 97 percent of D.C. residents are covered by insurance. “It means getting more people connected to the right people at the right time,” she said. “Why are people avoiding the doctor their first three months of pregnancy?”

Asked to suggest concrete steps they are taking to fill these gaps, Bowser and LaQuandra S. Nesbitt, D.C.’s Director of Health, spoke in broad terms about finding ways to reach woman more proactively, as soon as they become pregnant. Bowser suggested using technology to connect pregnant mothers with medical providers.

“If people can swipe to the right to find dates why can’t they figure out how to get better access to our service,” she said. “We can’t continue to only do the things we’ve done in the past.”

For one organization, the D.C. Primary Care Association, a key solution lies in something called “Centering,” a form of group prenatal care, according to a report released by the association on Wednesday. The report’s researchers conducted 31 in-depth interviews with medical providers as well as low-income women of color in D.C.

“Centering” involves a recommended schedule of 10 prenatal visits, each 90 minutes to two hours long, in groups of eight to 10 expectant mothers all in the same stage of pregnancy.

Centering encourages teaching expectant mothers how to play a role in their own medical care, engaging them in taking their own weight and blood pressure, for example. Most importantly, it provides a support system, said DCPCA President and CEO Tamara Smith.

Expectant mothers, particularly low-income women of color, “often times feel alone,” Smith said. “There’s nobody that you’re talking to in the same stage of your pregnancy with the same fears.”

“Word of mouth is really powerful in these communities,” said Robyn Russell, a fellow with DCPCA who worked on the report. “It’s almost like a tipping point.”

In D.C., centering is currently offered at two organizations, Mary’s Center and Community of Hope, covering only a small segment of the population. But all of the current providers offering it said they are relying on grants that are set to expire. DCPCA is recommending that the city expand the program to more community centers, particularly Unity Health, and invest in the staff needed to coordinate and facilitate the group classes. Such an expansion, including hiring six personnel to coordinate the programs, could cost less than $1.5 million, DCPCA estimates.

The cost estimates would allow for six new Centering programs, with the capacity to reach 1,200 women, according to DCPCA.

Ebony Marcelle, Director of Midwifery at Community of Hope, helps coordinate and facilitate Centering classes, and says the program is essential for empowering women, particularly African American women, in a relaxed setting in which “we’re not talking at them.”

“There’s a huge level of distrust that’s generational, with medicine with healthcare,” Marcelle said. “We acknowledge that, we honor that, we respect that and we try to meet them where we are.”

According to America’s Health Ranking’s 2018 analysis of CDC data, about 36 women die for for every 100,000 live births in D.C. , compared to 20.7 deaths nationally. Only four states have worse rates.