Montgomery County is leaning hard on a two-decade-old nurse-led program and a network of local health partners to confront a stubborn, and often deadly, racial gap in pregnancy and postpartum outcomes. The county’s SMILE initiative - short for Start More Infants Living Equally healthy - pairs nurse case managers with expectant Black mothers for home visits, childbirth education and postpartum follow-up, even as county leaders push for bigger, system-level changes.
According to the National Center for Health Statistics, the maternal mortality rate for Black women was 50.3 deaths per 100,000 live births in 2023. Montgomery County Health Officer Dr. Kisha Davis told WTOP that the higher rate of negative outcomes “is rooted in inequities related to health care access,” and she pointed to social drivers such as housing and transportation. Local leaders say numbers like that demand both better clinical care and stronger community supports.
SMILE Program Offers Nurse Visits And Wraparound Help
The county-funded African American Health Program runs SMILE, a nurse-led home-visiting effort that follows Black mothers from pregnancy through a child’s first birthday. According to the African American Health Program, SMILE provides childbirth and breastfeeding classes, regular nurse check-ins, transportation help, appointment coordination and assistance with insurance and referrals. AAHP reports that the program’s maternal supports and reach have grown in recent years and points to strong breastfeeding outcomes among participants.
How SMILE Coaches Self-Advocacy In The Exam Room
Nursing supervisor Iye Kanu told WTOP that SMILE teaches a decision-making tool known as BRAIN, which stands for Benefits, Risks, Alternatives, Instincts and Nothing. The framework is designed to help mothers prepare questions and weigh options during clinical visits. Kanu said SMILE offers free childbirth-education classes at least three times a year and stays with families through the postpartum period to connect them with breastfeeding and mental-health supports. Participants and nurses say that mix of concrete help and education makes it easier for women to speak up in busy hospital and clinic settings.
County Review Finds Racial Gaps Are Still Stark
An Office of Legislative Oversight review released last year found that Black women in Montgomery County experience higher rates of severe maternal morbidity, cesarean delivery and preterm birth, with a maternal morbidity rate roughly 54 percent higher than the countywide average. The report, summarized by Montgomery Community Media, called for a mix of clinical, community and policy interventions to narrow those gaps, including expanded access to midwives and doulas and stronger postpartum mental-health care. Council members and health advocates say those recommendations are shaping county planning and outreach efforts.
Officials Say Health Care Alone Cannot Fix The Problem
Public-health leaders in and beyond Montgomery County argue that clinical care by itself cannot erase racial disparities when social determinants such as housing, transportation, economic opportunity and structural racism shape risk long before delivery. National analyses by organizations such as the Commonwealth Fund stress that local programs must be paired with policy and system changes to produce lasting improvements. County officials say efforts like SMILE are one important piece of a broader response that also involves hospitals, primary-care clinics and mental-health services.
Where Black Moms Can Find Help In Montgomery County
For mothers in Montgomery County who are looking for support, the African American Health Program operates SMILE and other maternal-health services. The program’s site lists classes, enrollment details and a contact line at (240) 777-1833, and more information is available on the African American Health Program website. Community partners and hospital outreach events also link families to doulas, lactation consultants and mental-health resources.
