Founded in 1999 under the leadership of the March of Dimes, Generate Health’s first priorities were to address health care access and utilization for low-income women, birthing people, and children, the rising infant mortality rate, and to establish a sustainable infrastructure for ongoing collective impact.

Throughout our history, we have enhanced community services that focus on improving the health of women, birthing people, and children. Generate Health brings together diverse stakeholders from community, non-profit, for-profit, government, and academic institutions to leverage pooled resources and expertise to solve problems, attract and focus financial and human resources where they are needed most, and avoid duplication where resources are scarce.

Our Racial Equity and Reproductive Justice Journey

A Stake in the Ground

The murder of Michael Brown Jr., the exposure of systemic and structural racism by the Ferguson Commission, and Forward through Ferguson’s organizing work were very influential on our staff and Board between 2014 and 2017.  We realized that our previous approach of improving pregnancy outcomes for all families did not result in equitable outcomes for Black families – in fact, health disparities between Black and white moms and babies were widening. We learned that if we wanted to achieve our organizational goal of seeing every baby in St. Louis celebrate their first birthday, we first needed to close the disparity gap.   And it became clear that for us to impact meaningful change for families in our region, we had a responsibility to advance racial equity in our sphere of influence.

In 2017, our Board of Directors decided that it wasn’t enough to simply embed racial equity into our strategic plan.  We needed to center racial equity in our vision, mission, and approach.  We started by adopting a North Star in 2017 – a bold stake in the ground – of achieving zero racial disparities in infant and maternal health.

Throughout 2018, our staff and Board communicated the mission change with key stakeholders, explored the requirements and competencies needed to successfully catalyze systems change, evaluated the alignment of initiatives with our new mission, and crafted a two-year plan comprised of primary outcomes, indicators, goals, objectives, strategies, and deliverables. The two-year period was selected due to the degree of change and learning we anticipated needing in order to live into our new mission.

Since this mission change, we have focused our efforts on centering the leadership of Black women and birthing people to advocate for community-driven policy and practice change. We worked with partners to transform the FLOURISH initiative to be community-led. And we have undergone thorough examination of our culture, policies, and practices to ensure we are aligned both internally and externally with our commitment to racial equity.

Unflinching Examination

In early 2020, we engaged Crossroads Antiracism Organizing and Training’s expertise in conducting a racial equity audit of our organization. The purpose of embarking on the institutional racial equity audit was to assess how our organization’s programs, constituent relationships, organizational structure, and policies continued to create and/or maintain systemic racism. The racial equity audit’s objectives were to build understanding and analysis of systemic oppression, assess our organization’s culture to learn where systemic racism still thrives despite our stated commitments, and to identify and recommend changes to our organizational culture and structures that will set us on a path to becoming a fully inclusive, multicultural, and antiracist institution.

A Racial Equity Audit Team, consisting of our Board and staff at all levels of the organization, was trained in the auditing process. The training began the week before the world shut down due to the COVID-19 pandemic. The audit team continued to meet monthly and was dedicated to analyzing the findings in order to develop recommendations.

The Racial Equity Audit Team findings and recommendations were affirmed by our Board of Directors, staff, community leaders, and members of our Ambassador Board in August 2022 and subsequently incorporated into our strategic plan for 2023 – 2025. The following recommendations reflect the next steps on our journey toward becoming a more anti-racist organization. Implementing these changes will enable our continued growth and evolution.

1. Clear and Bold Identity: Since changing our mission in 2017, Generate Health has experienced rapid changes and learning. During a period of so much change, there has been a lack of clarity and confidence about how to define and describe our commitment to anti-racism. At the same time, this commitment requires clearer and more explicit communication about who we are, what we stand for, and how we will be in relationship with stakeholders. The Racial Equity Audit Team recommended that Generate Health clarify and convey an intentional anti-racist identity that prioritizes Black women and birthing people in St. Louis. This led to us revising our mission, vision, and value statements in 2022 and implementing a plan to communicate our commitments with stakeholders in 2023.

2. Undivided Accountability: As a coalition, Generate Health has historically centered institutions in its structure, not community members impacted by racial inequities. Attempting to center Black families while also being accountable to organizations hinders trust, diminishes effectiveness, and leads to unclear decision-making roles and power. Generate Health’s primary accountability will be to the Black community of women, birthing people, and their families. This will be done by restructuring who holds membership power, co-creating community decision-making roles, and defining partnership principles that guide how we engage with institutions.

3. Prioritize Staff Culture: Generate Health will need to prioritize its internal culture to ensure its anti-racism commitment is experienced both inside and outside the organization. We will create and implement an equity-centered staff culture that a) increases clarity, transparency, and inclusion in decision making, b) promotes multi-directional communication and feedback loops, and c) increases sense of belonging and value. This will be done using reflections and recommendations from Staff Healing Salons that were held throughout 2022.

4. Assign Responsibility: The audit report is not the end of the work; rather it is a milestone. More stakeholders are needed in the next phase to spread the findings and make them last. Progress will require monitoring, steering, and creating mechanisms for feedback. Generate Health has established a Racial Equity Transformation Team to oversee the implementation of the Audit Team’s recommendations and hold the organization accountable.

Acknowledging Intersectionality — Reproductive Justice

In 2022, following multiple years of internal discussion and with the added pressure of the Supreme Court’s decision in the Dobbs v. Jackson Women’s Health Organization case, it became clear to us that we cannot achieve our North Star – achieving zero racial disparities in infant and maternal health – if we maintain our passive stance on reproductive justice. We know that bodily autonomy has both historically been and continues to be denied to Black women and birthing people and that Black positive maternal and infant health outcomes depend on the full spectrum of reproductive health services being both available and accessible, from contraceptives to perinatal care to abortion. We follow the guidance of leadership of Black-led organizations in this space, like Sister Song, who nearly 30 years ago defined reproductive justice as:

The human right to own our bodies and control our future
The human right to have children
The human right to not have children, and
The human right to parent the children we have in safe and sustainable communities.

In late 2022, after holding listening sessions with our community leaders, we officially incorporated reproductive justice into our organizational values.

Next Steps: Refining and Deepening Commitment

So far in 2023, we have made progress towards each of the audit team’s recommendations. One of the major recommendations was to clarify who we are accountable to and what we are working to co-create with community. To that end, in late 2022, we officially adopted a new mission, vision, and value statements that went beyond our previous broad commitment to racial equity. These will be revealed by the end of the summer when we launch a new website that helps us more clearly and boldly convey our identity.

Additionally, we formed a new Generate Health Community Leaders Cabinet comprised of prior FLOURISH Cabinet and Consumer Advisory Board members to co-design decision making and accountability structures. Further, our Governance Committee is preparing recommendations for reimagining our membership structure. Finally, a Transformation Team, consisting of community members, board, and staff, was established to hold Generate Health accountable for implementing the recommendations from the racial audit.


Generate Health Racial Equity Audit

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