MAMAFESTO: Toward A Community-Driven Service Design Approach For Black Maternal Health Equity

Abstract

Black mothers and birthing people in the United States continue to experience profound maternal health inequities shaped by enduring histories of racism, medical violence, and systemic neglect. While dominant maternal health interventions often center hospitals, providers, and technological innovation as primary sites of change, Black communities have long cultivated their own infrastructures of care rooted in cultural knowledge, collective responsibility, and ancestral wisdom. This dissertation examines Black maternal health through the lens of community care, service design, and Black feminist thought, arguing that Black communities are not passively navigating maternal health systems, but actively designing alternative systems of care. Guided by Ruha Benjamin’s framework of Viral Justice, this dissertation takes a community-driven and justice-oriented approach to understanding how everyday practices of care generate broader possibilities for systemic transformation. Across three interconnected investigations, this work explores community care in Black maternal health through interviews with Black mothers in the Seattle-Tacoma area, a directed content analysis of Black-led maternal health organizations, and a multimodal critical reflection on Cradles & Culture, a community baby shower I designed as a form of research reciprocity and community contribution. Through these investigations, the dissertation introduces the TRIBE framework to articulate five dimensions of community care in Black maternal health: Tangible, Relational, Informational, Birthworker, and Emotional support. It further develops the concept of community-driven service design (CDSD), an approach to service design in which community-defined values and practices function as the primary organizing logic for how care systems are imagined, structured, and delivered. This dissertation also advances marginal sensibilities and w/reckoning as critical approaches to design epistemology and research practice, arguing that the lived experiences of marginalized researchers generate important forms of design knowledge often excluded from dominant research paradigms. Together, these contributions challenge institution-centered models of maternal health innovation and reposition Black community care as a legitimate and generative site of design knowledge, technological imagination, and justice-oriented research practice. Ultimately, this work calls for maternal health systems, research approaches, and technologies that honor and extend the care infrastructures that Black communities have long enabled and sustained.